Evaluation of an Amniotic Membrane-Collagen Dermal Substitute in the Management of Full-Thickness Skin Defects in a Pig

Abstract

BackgroundTo minimize the inflammatory reaction and improve healing, a new modified dermal substitute composed of an atelocollagen, chondroitin-6-sulfate, and amniotic membrane (AM) was applied to full-thickness skin defects in a pig. Atelocollagen was extracted from bovine skin, and two modified dermal substitutes were generated according to the cross-linking type.MethodsThe AM-collagen dermal substitutes were characterized and compared with currently used dermal substitutes in a pig skin defect model. There were five experimental groups: dehydrothermal (DHT) cross-linking atelocollagen with the AM on the top (AM-DHT), DHT and chemical cross-linking atelocollagen with the AM on the top (AM-DHT/chemical), Terudermis, Integra, and AlloDerm. After 3×3 cm full-thickness skin defects on the back of a pig were created, each dermal substitutes dermal substitutes was randomly grafted on the defects. Two weeks after grafting, autologous partial-thickness skin was over-grafted on the neodermis. The take rate of the dermal substitutes, skin, and histological sections were all assessed at 1, 2, and 4 weeks postoperatively.ResultsMore rapid healing and a higher take rate were evident in the AM-DHT and Terudermis groups. Histological examination revealed fewer inflammatory cells and more fibroblast hyperplasia in these two groups. Four weeks after surgery, the amount of newly formed collagen was significantly more appropriate in the AM-DHT group.ConclusionsThese observations provide supporting evidence that a newly developed amniotic-collagen dermal substitute may inhibit inflammatory reactions and promote wound healing.

Immunomodulatory effects of amniotic membrane matrix incorporated into collagen scaffolds

“…Hyaluronic acid (HA), shown to have a dominant presence in fetal wounds both in the wound ECM and surrounding fluid, has been used in three‐dimensional skin grafts to reduce scar formation . Amniotic membrane has also been used in the treatment of skin wounds . As a result, our effort here investigated whether CG scaffolds containing hyaluronic acid or amniotic membrane matrix could reduce the immune response associated with interleukin‐1beta (IL‐1β) in tenocytes.…”

“…16 Separately, the amniotic membrane (AM), known for its anti-inflammatory and antimicrobial properties as well as scarless wound healing capacity, is the innermost layer of the placenta. Clinicians and scientists have shown that the intact AM sheet is valuable in the treatment of corneal surfaces, [17][18][19] skin wounds, 20,21 oral cavity reconstruction 22 and many other reconstruction applications. 23,24 In addition, the use of dry, micronized human amnion membrane has been shown to reduce cartilage degeneration in an osteoarthritic rat model.…”

Amniotic membrane as a biological dressing in infected wound healing in rabbits

“…The characteristics of AM such as antibacterial activity 5,13,19 that are likely due to elements such as interferon 24 , lysozyme, transferrin, progesterone [24][25][26] , 7S immunoglobulin, and B1c/B1a globulin present in amniotic fluid [20][21]23 . Its low antigenicity is due to the absence of certain surface antigens on amniotic epithelial cells (HLAA, HLAB, HLAC, and HLAD) In this study, organized fibrosis with more collagen fibers and fewer fibroblasts was observed in all the groups beginning on Day 14.…”

“…According to Fontenla et al to Schwanet al 6 , the use of AM began with De Rotth in 1940 in ophthalmology, the specialty in which AM is currently most heavily researched. Studies have described its application in varicose ulcers 7 , burns 8 , neovaginal reconstruction 9 , urinary bladder reconstruction 10 , nerve damage 11 , oral wounds 12 , skin trauma 13 , ocular injuries 14 , adhesion control, and peritoneal structure scarring 15 .…”

Naturally derived biomaterials for addressing inflammation in tissue regeneration

“…96 In a porcine full thickness skin defect, cross-linked collagen-amnion dermal substitutes exhibited few inflammatory cells, rapid healing, and good neovascularization. 34 Micronized, dehydrated human amnion membrane has been shown to reduce cartilage degeneration in an osteoarthritic rat model. 35 …”