Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study

Abstract

Background: Since the development of the meshed skingrafts and the availability of different meshing expansionsizes, the sizes of the meshed skin grafts interstices like allopen wounds became a problem because they increase themetabolic needs and put the patients at the risk of infection.The amniotic membrane satisfies most of the criteria for anideal biological wound dressing to solve such a problem.Aim of Study: To determine the rate of healing of theinterstices of meshed skin autograft of 1:3 meshing sizeapplied to post burn raw areas when covered by fresh amnioticmembranes.Patients and Methods: This study was conducted on 30patients who had post burn raw areas with TBSA less than30% divided into 2 groups Group (1): Used meshed STSG(1:3) without amniotic membrane coverage Group (2): Usedmeshed STSG 1:3 then covered with fresh amniotic membrane.Biopsies were taken and examined. Patient and Observer ScarAssessment Scale (POSAS) was used to evaluate the aestheticout come.Results: Amniotic Membrane (AM) did not improve skingraft take but it improved the macroscopic healing of theinterstices which showed significant p-value 0.005* andregistered valuable decrease in all items of Patient and ObserverScar Assessment Scale (POSAS) that showed significant pvalues.Also, AM accelerated the healing process histologically:The chronic inflammatory cells started to appear early (pvalue:0.003*). In the 10th day both the maturation of theepithelium and the transformation of newly formed capillariesinto mature ones showed p-values (0.006*).Conclusion: Amniotic membrane enhanced maturationof epithelium, increased the transformation of the newlyformed capillaries into mature ones, accelerated the initiationof the proliferative phase of wound healing, promoted the reepithelializationof the interstices of the meshed graft andled to a better cosmetic outcome.