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elHeneidy et al Dovepress

5,6
and antimicrobial effects. The reduction in scarring after on the rate of healing of such nonhealing ulcers. Patients were
application of AM to wounds might be due to the anti- recruited from the outpatient clinics or the inpatient wards
inflammatory effects, acceleration of epithelialization, 3,4,7 of the Department of General Surgery, Faculty of Medicine,
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and inhibition of fibrosis. Accelerated reepithelialization Cairo University and Department of Vascular Surgery,
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was also demonstrated by Maral et al after covering split Faculty of Medicine, Assiut University from June 2012 to
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thickness skin graft with AM in rats. Loeffelbein et al June 2015. Each patient signed an informed consent after
demonstrated accelerated formation of basement membrane accepting to be enrolled in the study. Ethical aspects whether
in wounds treated with AM that might be due to the release substantial or procedural have been implicated in this study
of growth factors. One of the most important properties of and approval was obtained from the Faculty of Medicine,
AM as a skin substitute is pain relieving which may be due Ethical Committee of Cairo University (30-9-2012).
to diminished inflammation, better hydration of wound bed, Patients were then randomly divided into two different
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and protection of exposed nerve endings. AM expresses groups. Group I (the control group) included eleven patients
few antigens, which accounts for its good tolerability and with eleven chronic leg ulcers in whom ulcers were treated
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the absence of rejection reactions. AM expresses many with conventional wound dressings that were changed daily
neurotrophic and angiogenic factors: endothelin-2 and -3, vas- for 8 weeks. Group II (the study group) included 14 patients
cular endothelial growth factor, vascular endothelial growth with 14 chronic leg ulcers. The AM was placed in contact
factor-B, Tie-2 angiopoietin receptor, ephrin-A2, ephrin with the ulcer and held in place with a secondary dressing,
receptors A2, B1, B3, B4, B5, neuropilin-2, nerve growth which was changed daily. Inclusion criteria were presence
factor receptor, and semaphorin-F19 as well as erythropoi- of leg ulcers for more than 3 months with no improvement
etin and its receptor that contribute to healing of wounds. 12,13 despite standard treatment and age between 26 and 43 years.
Some studies demonstrated the effectiveness of AM graft Exclusion criteria were ulcers with ongoing active infection
for healing of wounds. Mermet et al put an AM graft for and presence of diabetes. Full history taking and clinical
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15 chronic leg ulcers and healing occurred in all patients. assessment were done with special reference to previous
Pesteil et al used cryopreserved AM in eight patients with treatment and surgery, diagnosed diabetes and/or hyperten-
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resistant vascular ulcers. Tolerance to the graft was excel- sion, causes, types, and duration of ulcers present.
lent with healing of six out of eight patients with significant The follow-up during treatment period includes assess-
improved pain. Alsina-Gibert and Pedregosa-Fauste used ment of ulcer healing and pain. Ulcer healing was assessed
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AM for four refractory ulcers with a mean 81.93% reduction using the percentage of the healed wound area and healing
of ulcer size after 16 weeks. Litwiniuk et al suggested the rate. Using ImageJ program (Rasband, W.S., ImageJ, US
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potential role of matrix metalloproteinase inhibitors present National Institutes of Health, Bethesda, Maryland, USA), the
in radiation-sterilized amnion dressing in healing of 23 out wound areas were analyzed and a percentage of the healed
of 25 patients with chronic venous ulcers. Sheikh et al used wound area was calculated, in respect to the original wound
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dehydrated amnion to provoke healing of chronic wounds area and the final wound area after 2 weeks and at the end
in four patients and healed wounds did not recur on long- of 2 months according to the formula:
term follow-up. A similar study was done by Zelen et al
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who used dehydrated AM in diabetic foot ulcers with com- Percentage of Original wound area − Final wound area
plete healing of 37 out of 40 ulcers. With respect to the low healed wound area = Original wound area × 100
cost, wide availability, and easy preparation, AM can be an
ideal graft for chronic refractory ulcers.
The healing rate was then determined, in respect to
Subjects and methods the original wound area, and the final wound area reached
study design according to the formula:
This was an experimental, comparative, and randomized
clinical trial. Healing rate = Original wound area Finalwound area−
Time consuumed to reach finalwound area
Description of patients and collection of data
This study was performed to test a technique for the treatment The wound area is calculated by the formula for deter-
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of chronic nonhealing wounds using AM to express its effect mining the area of an ellipse ((length × width) × π/4).

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