Download - Cry Op Reserved Amniotic Membrane

8/6/2019 Cry Op Reserved Amniotic Membrane

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Dr. Sangeeta Sehrawat


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Innermost lining of fetal membrane that is in contact with thedeveloping fetus.

Histologically: loosely connected to chorion, consists of a simple

cuboidal epithelium, basement membrane, and an avascular

stroma.


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Adapted from Parry and Strauss (1998)


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1. Reduce inflammation

2. Diminish the occurrence of adhesions and scarring,

3. Modulate angiogenesis,

4.

Promote wound healing,5. Promote epithelialization, maintains a normal epithelial

phenotype

6. Antimicrobial properties. (Solomon A et al)


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A cryopreservation methodology was developed by Tseng to

preserve the biologic properties that this tissue exhibits in

utero.

Factors contributing to its biologic actions of regulated

through IL-1, -4, -6, epidermal growth factors, basic FGF,

(TGF)-b, TGF-a, keratinocyte growth factor, neural growth

factor, endostatins, anti-angiogenic factors, &collagen I, II,

III, IV.

Natural barrier to protect the fetus from infections &

trauma because of the lack of a fetal immune system.


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Applications:

1. Ocular surface reconstruction: graft to replace damaged tissue,biologic dressing, or a combination of both.

2. Helps in ocular surface wound healing & may be used for treatment of

conjunctival & corneal lesions.

3. Reduce acute inflammatory response in scalpel, laser surgery & burns.

4. Management of Stevens-J

ohnson syndrome.5. Decreases chronic inflammation & necrosis in HSV & VZV infected

tissues: reduces recruitment of several populations of inflammatory

cells including PMNs, CD3+ cells, CD4+ T cells, and CD11b+ cells.

6. Facilitation of lipid peroxidation & apoptosis of keratinocytes

(programmed cell death).

7. Effective in covering and repairing extensive ocular defects afterexcision of masses >2.0 cm.

Typically, the wounds heal without inflammation


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Stromal side of graft attached to a white nitrocellulose filter paper

This side is sticky compared with epithelial (shiny & non-sticky).

CAM must be placed on the lesional surface with the stromal side incontact with the wound.

Fibrin glue sticks to stromal side adherence of membrane, with or

without suturing.

Tissue damage is deep: multiple layers


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Obtained from healthy maternal donors during an elective

Caesarian section who are negative for hepatitis B, surfaceantigen and core antibody, hepatitis C, syphilis, HIV 1 & 2, and

H T-lymphotropic virus 1 and 2 antibodies.

Maternal tests are repeated on the donors 6 months after

delivery and before clinical use is allowed.

Donors are also screened for other infectious diseases;

malignant, autoimmune, and neurologic conditions; and social

habits and other exposures.


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Epithelial healing occurs underneath layer of CAM. CAM does not fuse with host epithelium or prevent

epithelialization.

Completely dissolves after providing its therapeutic actions.

Bari et al: in superficial burns, CAM adheres, remains until

epithelialization is complete.

Incorporated into host tissue when used as a substrate

replacement or permanent graft.

Excellent membrane for reconstructive surgery: easily

accessible, ethically acceptable, easy to use, & easily stored

without alteration to its therapeutic properties.


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Would be effective in the prevention of unfavorable functional

& cosmetic results related to periodontal surgical wound

healing. Contains laminin , mitogenic growth factors, and anti-

inflammatory proteins: ideal for supporting growth of

epithelial cells, thus facilitating migration, reinforcing

adhesion, and promoting differentiation.

Anti-inflammatory effect by the facilitation of the apoptosis ofmacrophages.

CAM suppresses tumor growth factor b1 and, therefore, the

deposition of collagen.

Fibronectin reduces myofibroblastic differentiation & collagen

contraction: anti-scarring effect.


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To assess the value of CAM in helping the

cicatrization and wound healing afterplacement of dental implants.


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15 pts (9 M + 6 F)

Inclusion criteria: at least 2 bilateral dental implants with

placement occurring during a single clinical session, be male or

female patients >18 years.

Exclusion criteria: pregnancy; a history of collagen diseases

such as Sjogren syndrome, lupus erythematosus, scleroderma,

dermatomyositis, or rheumatoid arthritis; immunodeficiency;

infectious disease; infection at either surgical site or a history

of radiation therapy to the head and neck. Moderate to severegingivitis and/or periodontal disease.


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LA, crestal incisions over edentulous alveolar sites & full-thickness

flaps. Osteotomies for implant placement, performed bilaterally.

Before wound closure of experimental site, CAM was placed over thesurgical wound with stroma in contact tissues.

Postop: 0.12% chlorhexidine gluconate rinses twice a day for 2 weeks.Amoxicillin (500 mg, 3/ day) for 1 week. Clindamycin if allergy to

penicillin. Ibuprofen (800 mg, 3/day)


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1) Self-reported pain (Likert scale), 0 = not present to10= worstpain imaginable.

2) Wound size (mm) using UNC #15 probe. Lesion was measured

across its greatest dimension.

3) Degree of epithelialization: UNC #15. measured until complete

healing. Measurements until complete healing occurred(complete epithelialization). Recorded as:

0 = no epithelialization;

+ = initial epithelialization with connective tissue exposed;

++ =complete epithelialization.

4) Clinically apparent scarring was recorded as 0 = not present; += present.

5) Infection: 0 = not present; + = present.

6) Any post-surgical adverse


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Outcome measures obtained 7 times: at baseline

(immediately after surgical procedure), 72 hours, 144

hours, 2 weeks after surgery, and 1, 1.5, and 3 months

after surgery.

Code was broken, and the membrane and control sides for

each patient were identified after all patients had been

scored.


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Non-parametricWilcoxon matched-pair rank-sum test was used

for inferential testing because the sample size was relatively

small, most measurements were ordinal in nature, and most

distributions were non-normal, except for wound size, which

showed a normal distribution at baseline (but not thereafteras healing progressed).

Chi 2 analysis was used for yes/no categoric comparisons.


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For 6 days


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Scarring

Inflammation: not significant


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Limitations of the Study

Small sample size: findings are preliminary.

Type of lesion. No difference in the final outcome of the

dental implant surgery was found. However, statistically

significant differences regarding the cicatrization of thewound were noted.

Not cost effective.

However, the results are promising for other types of

wounds.


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Regarding dental implants, the placement of

CAM was not cost effective.

However, the results were promising for

other types of wounds and new studies withlarger samples that evaluate other ulcerative

oral conditions are encouraged.


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Solomon A, Wajngarten M, Alviano F, et al. Suppression ofinflammatory and fibrotic responses in allergicinflammation by the amniotic membrane stromal matrix.Clin Exp Allergy 2005;35:941-948.

Hong-Jeng Chen, Renato T F Pires, Scheffer C G Tseng.Amniotic membrane transplantation for severe

neurotrophic corneal ulcers. Br J Ophthalmol 2000;84:826833

Jin A Choi, Jun-Sub Choi, Choun-Ki Joo. Effects of amnioticmembrane suspension in the rat alkali burn model.Molecular Vision 2011; 17:404-412.

Annamma John, John Oommen. Use of amniotic membranein dermatology. Indian J Dermatol Venereol Leprol2010;76:196-7.


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Richard M. Jay, DPM, FACFAS. Initial Clinical Experience

with the Use of Human Amniotic Membrane Tissue During

Repair of Posterior Tibial and Achilles Tendons. Professor

of Foot and Ankle Orthopedics, Temple University School

ofPodiatric Medicine Div. of Orthopedics, Regional

Medical Center, South Jersey Healthcare Vineland, New

Jersey

Ardeshir Lafzi. Amniotic membrane: A potential candidate

for periodontal guided tissu regeneration? Medical

Hypotheses (2007) 69, 454473

Rinastiti M, Harijadi, Santoso ALS, Sosroseno W.

Histological evaluation of rabbit gingival wound healing

transplanted with human amniotic membrane. Int J Oral

Maxillofac Surg 2006;35(3):24751.


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