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Bianchi C, Cazzell S, Vayser D, Reyzelman AM, Dosluoglu H, Tovmassian G. A multicentre randomised controlled trial evaluating the efficacy of dehydrated human amnion/chorion membrane (EpiFix ® ) allograft for the treatment of venous leg ulcers. Int Wound J 2017; 15:114-122. [PMID: 29024419 PMCID: PMC7949978 DOI: 10.1111/iwj.12843] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 01/02/2023] Open
Abstract
A randomised, controlled, multicentre clinical trial was conducted to evaluate the efficacy of dehydrated human amnion/chorion membrane (EpiFix) allograft as an adjunct to multilayer compression therapy for the treatment of non-healing full-thickness venous leg ulcers. We randomly assigned 109 subjects to receive EpiFix and multilayer compression (n = 52) or dressings and multilayer compression therapy alone (n = 57). Patients were recruited from 15 centres around the USA and were followed up for 16 weeks. The primary end point of the study was defined as time to complete ulcer healing. Participants receiving weekly application of EpiFix and compression were significantly more likely to experience complete wound healing than those receiving standard wound care and compression (60% versus 35% at 12 weeks, P = 0·0128, and 71% versus 44% at 16 weeks, P = 0·0065). A Kaplan-Meier analysis was performed to compare the time-to-healing performance with or without EpiFix, showing a significantly improved time to healing using the allograft (log-rank P = 0·0110). Cox regression analysis showed that subjects treated with EpiFix had a significantly higher probability of complete healing within 12 weeks (HR: 2·26, 95% confidence interval 1·25-4·10, P = 0·01) versus without EpiFix. These results confirm the advantage of EpiFix allograft as an adjunct to multilayer compression therapy for the treatment of non-healing, full-thickness venous leg ulcers.
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Affiliation(s)
- Christian Bianchi
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | | | | | | | - Gregory Tovmassian
- Center for Clinical Research, Inc. Sacramento Foot and Ankle Center, Sacramento, CA, USA
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Mrugala A, Sui A, Plummer M, Altman I, Papineau E, Frandsen D, Hill D, Ennis WJ. Amniotic membrane is a potential regenerative option for chronic non-healing wounds: a report of five cases receiving dehydrated human amnion/chorion membrane allograft. Int Wound J 2015; 13:485-92. [PMID: 25974156 PMCID: PMC7950060 DOI: 10.1111/iwj.12458] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/31/2023] Open
Abstract
A case series of five patients with a total of six chronic non-healing wounds (>30 day duration) were non-randomly selected to evaluate the performance, safety and handling properties of dehydrated human amnion/chorion membrane allograft, an amniotic membrane scaffolding product. The patients had lower extremity wounds that had previously failed standard of care within a university outpatient/inpatient wound healing programme. Five wounds treated with dehydrated amnion/chorion membrane allograft showed a mean 43% area reduction from baseline (51% median) at 3 weeks into treatment and completely healed with a 64-day median time to closure (SD ±27·6 days). One wound worsened at 3 weeks and was found to have a complete central vein obstruction that was treated with long-term mild compression but still eventually healed at 6 months. Removing this outlier, the four responding wounds had a 72% mean and 69% median change in area from baseline, at the 3 week point. All five patients received only one application of dehydrated human amnion/chorion membrane allograft, and there were no adverse events. The product was easy to use, administer and handle. In summary, dehydrated human amnion/chorion membrane allograft appears to be a safe, effective and easy to use therapy for chronic non-healing wounds. This study describes the details of these clinical cases and provides an overview of the current evidence on the use of amniotic tissue in clinical practice.
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Affiliation(s)
- Andrew Mrugala
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Audrey Sui
- Chicago College Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA.,Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Malgorzata Plummer
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Igor Altman
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Elaine Papineau
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Devn Frandsen
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Wound Healing, Grand View Hospital, Sellersville, PA, USA
| | - Danielle Hill
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - William J Ennis
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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