References
Cryopreserved amniotic membrane in the treatment of limb skin defects of aplasia cutis congenita: a case study
Abstract
Objective:
To report the efficacy and long-term outcomes of treating the skin defects of aplasia cutis congenita (ACC) with cryopreserved amniotic membrane (AM).
Method:
Human amnion was obtained from the caesarean delivery of a full-term healthy pregnancy and processed in a sterile laminar flow hood, and cryopreserved in liquid nitrogen. The structure of the AM was investigated histologically and the viability of the epithelial cells was assessed after cryopreservation and compared with fresh AM and with AM preserved in phosphate-buffered saline (PBS) at 4°C. The cryopreserved AM was applied onto the lower limb skin defects of a one-month old baby with ACC. Timely AM changes were performed as necessary until the wounds healed.
Results:
The structure of the cryopreserved AM was intact, with little visible difference compared with fresh AM. The viability of the epithelial cells was partially lost but still much better retained than in those preserved in PBS at 4°C. The limb skin defects were gradually re-epithelialised upon application of the AM and were completely healed after one month. The 4-month and 2-year follow-ups presented good skin texture and colour, without hypertrophic scar formation.
Conclusion:
In this case study, cryopreservation of AM presented a well preserved stromal compartment and viable epithelial layer. It also offered features such as pain relief, good attachment and adhesiveness, improved wound healing and suppressed scar formation in the treatment of ACC skin defects.
Human amniotic membrane (AM) for clinical use is usually obtained via caesarean delivery from a full-term pregnancy after screening for known human contagious diseases such as human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV) and syphilis.1 AM presents unique characteristics for improving wound healing. For example, its anti-fibrosis, anti-inflammatory and anti-infection properties, its immune privilege, potential for pain relief and re-epithelialisation induction.2,3,4,5,6 Additionally, the cells in AM are mainly epithelial cells, which secrete various cytokines and growth factors necessary for wound healing.7 The preservation of an intact epithelial layer may also contribute to the prevention of microorganism invasion as well as keeping the wound from drying out.
AM may be processed for the coverage of skin wounds and corneal epithelial injuries in vivo. In some studies, AM has been decellularised and lyophilised for long-term storage and good accessibility; some studies have prefered to adopt fresh or cryopreserved AM.8,9,10
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