Use of Amniotic Membrane, Amniotic Fluid, and Placental Dressing in Advanced Burn Patients

Abstract

Introduction: The development of wound infections is the most common cause of mortality and morbidity among burn patients. A variety of dressings have been used to cover and reduce burn wound sepsis and promote wound healing. The aim of the present study was to examine the effectiveness of composite and judicious use of different stem cell-rich pregnancy-specific biological substances (PSBS) such as freshly collected amniotic membrane, amniotic fluid, and the placenta in case of extensive burn wound.

Materials and methods: Patients with more than 20% wound were admitted, and options were given for conservative management with PSBS dressing at a nonteaching hospital or provided with referral facility at the burns unit of another tertiary-level government hospital. Those who opted for treatment with PSBS (procured from hepatitis-, syphilis- and HIV-seronegative mothers having undergone cesarean deliveries) were treated initially at Bejoygarh State Hospital (1999–2006) and the same regimen was followed later at Vidyasagore Hospital (2006–2009). The area affected included both partial to complete thickness thermal burns. Patients suffering from chemical burns, or burned areas in sensitive parts of the body such as the genitals or face, were also included in this study from 1999 to 2009.

Result and analysis: Initially, 97 patients were randomly recruited for the present study of the utility of PSBS in the burn management. Of these, 33 patients, who did not agree to the PSBS protocol, were transferred to the burn unit of a tertiary-care hospital and were treated with broad spectrum antibiotics, application of silver sulfadiazine cream with electrolytes, and other supportive drugs to combat initial shock and infection till the patient was fit for autologous skin graft.

The rest, i.e., 64 burn patients (male 24, age 2–96 years, mean 36 ± 5.4 years and female 40, age 7–68 years, mean 32 ± 5.7 years) with 26–76% of total body surface area calculated on the basis of the famous rule of nine were enrolled in the present study for PSBS treatment (1999–2009).

Patients were treated with placenta (Step 1). After washing the burn site initially with normal saline, it was followed by gentle rubbing of the burned area with a freshly collected placenta’s maternal attachment site as a dressing material. This move may have a positive cytokine impact on the process of healing. Then, the burn site was washed with freshly collected amniotic fluid as a cell therapy source (because of its rich content of epithelial and mesenchymal stem cell component, leaving aside its antibacterial propensity as a helpful adjuvant) (Step 2). At last amniotic membrane is applied at the affected area (Step 3), as a temporary biological wound cover to expedite the healing and also to reduce the exudation, pain, and infection at the burn wound site with judicious application mode, i.e., chorionic side to augment vasculogenesis in early wound and the amniotic side to promote epithelialization lately. This is an effective step to augment the cell therapy component of the amniotic fluid.

Conclusion: The globally used skin substitutes currently available are costly and many are not universally available. The easily available and simple utilization of the biological waste generated from obstetric wards for the burn victims is very effective and rewarding. Use of stem cell-rich PSBS regimen has a profound regenerative impact in case of burn irrespective of the degree of burn. Its wider application is recommended on the basis of our experience of the present study, which has been carried out for 10 years (1999–2009).