Mohs Defect Repair with Dehydrated Human Amnion/Chorion Membrane

Refractory ulcers of both legs with psoriasis vulgaris successfully treated with dehydrated human amnion/chorion membrane: A case report

Patients with psoriasis are particularly susceptible to skin damage and secondary infections due to impaired skin defenses and chronic inflammation. This case report describes an 80-year-old male with psoriasis vulgaris and a refractory venous stasis ulcer that successfully achieved epithelialization following treatment with dehydrated human amnion/chorion membrane (dHACM; EPIFIX®). Despite initial management involving infection control and wound debridement, the ulcer exhibited minimal improvement until the application of dHACM. Within 4 wk, substantial wound contraction and epithelialization were achieved, eliminating the need for skin grafting. The regenerative properties of dHACM, employed in accordance with the TIMERS framework, facilitated effective wound healing through a minimally invasive approach. This case represents the first documented use of dHACM for a venous ulcer in a patient with psoriasis vulgaris, underscoring its potential as an innovative therapeutic option for managing chronic ulcers.

Engineered Skin Substitutes in Dermatologic Surgery: A Systematic Review

BACKGROUND

Artificial skin substitutes are a flexible alternative to autografting in Mohs micrographic surgery (MMS), but the characteristics and clinical outcomes of skin substitutes are not well defined.

OBJECTIVE

Summarize clinical data of skin substitutes in MMS for cutaneous malignancy.

METHODS

A MEDLINE/Embase/Web of Science search was conducted. Articles with original data on outcomes after skin substitute use in MMS for cutaneous malignancy were included. Articles not in English or without original data were excluded. Bias was assessed using the Oxford CEBM Levels of Evidence Table. Outcomes were synthesized using weighted averages. This study was prospectively registered in PROSPERO.

RESULTS

Of 1,007 articles, 40 met eligibility for inclusion. In total, 898 patients who underwent MMS and received a skin substitute were included. Xenografts were most commonly used ( n = 613). Semi-synthetic grafts (∼$<1/cm 2 ) and xenografts (∼$10/cm 2 ) are most affordable. Overall, outcomes were excellent for all skin substitutes, with a small proportion of patients experiencing correctable complications.

CONCLUSION

Skin substitutes are highly effective in MMS, with enormous potential. While the data demonstrate positive outcomes, they predominately draw from small, retrospective studies or case reports. There is also a scarcity of data comparing skin substitutes with each other or controls. Prospective studies are recommended.

Management of post-Mohs surgical wounds with a hypothermically stored amniotic membrane: a case series

OBJECTIVE

The aim of this case series is to present an alternative approach to managing post-Mohs Micrographic Surgery (Mohs) wounds with hypothermically stored amniotic membrane (HSAM).

METHOD

A case series of patients with post-Mohs wounds is presented, with four patients referred for hard-to-heal wounds following a Mohs procedure that was performed 1-3 months previously. All wounds underwent weekly assessment, debridement, and application of HSAM and secondary dressings. Treatment also included management of bioburden, proper skin care and compression therapy for lower extremity wounds.

RESULTS

This case series of seven wounds consisted of four females and three males with a mean age of 87.6 years. Mean wound size at first application of HSAM was 1.34±1.20cm2. All wounds closed, with an average time to wound closure of 43.7±27.1 days. Patients received an average of 4.6±2.5 HSAM applications. The four post-Mohs wounds with a history of being hard-to-heal had an average time to wound closure of 35.5±16.3 days, with an average duration of 86.5±32.4 days prior to the first HSAM application.

CONCLUSION

The results of this case series suggest that use of HSAM may provide an alternative approach to managing post-Mohs wounds. In addition, these findings suggest that HSAM may be of greatest benefit when applied early after Mohs surgery.

The Preparation and Clinical Efficacy of Amnion-Derived Membranes: A Review

Biological tissues from various anatomical sources have been utilized for tissue transplantation and have developed into an important source of extracellular scaffolding material for regenerative medicine applications. Tissue scaffolds ideally integrate with host tissue and provide a homeostatic environment for cellular infiltration, growth, differentiation, and tissue resolution. The human amniotic membrane is considered an important source of scaffolding material due to its 3D structural architecture and function and as a source of growth factors and cytokines. This tissue source has been widely studied and used in various areas of tissue repair including intraoral reconstruction, corneal repair, tendon repair, microvascular reconstruction, nerve procedures, burns, and chronic wound treatment. The production of amniotic membrane allografts has not been standardized, resulting in a wide array of amniotic membrane products, including single, dual, and tri-layered products, such as amnion, chorion, amnion-chorion, amnion-amnion, and amnion-chorion-amnion allografts. Since these allografts are not processed using the same methods, they do not necessarily produce the same clinical responses. The aim of this review is to highlight the properties of different human allograft membranes, present the different processing and preservation methods, and discuss their use in tissue engineering and regenerative applications.

From ancient Egypt to the dermatologic office: An overview of skin substitutes and modern-day applications in dermatologic surgery

Skin grafting (specifically xenografting) dates back to as early as 1500 before Christ (BC) in the Ebers papyrus, an Egyptian medical papyrus. In 1503, the use of human skin allograft was described in the manuscript of Branca of Sicily, and among the Hindu Tilemaker Caste approximately 2500-3000 years ago, surgeons repaired defects secondary to nose amputations of those who committed adultery and thievery. Over the years, many advancements in skin grafts/substitutes and their applications have propelled the field to focus on better graft survival, contracture prevention, cosmesis, and quality of life. We provide a general overview of skin substitutes (SS) with a particular focus on placental SS and their current applications in dermatologic surgery.

Industry updates from the field of stem cell research and regenerative medicine in November 2021

Latest developments in the field of stem cell research and regenerative medicine compiled from publicly available information and press releases from non-academic institutions in November 2021.