Use of Amniotic Tissue–Derived Allografts Post-Mohs Micrographic Surgery

A Preliminary Study Assessing Wound Closure Rate

Kayleen Seaton, DO; Dustin Mullens, DO; Jason Barr, DO; Elizabeth Hull, PhD; Richard Averitte, MD

Disclosures

Wounds. 2021;33(7):185-191. 

In This Article

Abstract and Introduction

Abstract

Introduction: When closure is not feasible, Mohs micrographic surgical wounds typically are left to heal by secondary intention and require weeks to close. Amniotic tissue–derived allograft (ATDA) has proven successful in promoting wound closure in diabetic and refractory wounds, and it may be beneficial for patients who have undergone Mohs micrographic surgery.

Objective: The authors conducted a preliminary study to assess the efficacy of ATDA in speeding wound closure time and improving cosmetic outcomes in the specified patient population.

Materials and Methods: Patients received an injection of amniotic fluid, an overlay of amniotic membrane, or standard of care. Photographs of wounds taken at the time of treatment and at each subsequent visit were analyzed.

Results: The cosmetic outcome and time to wound closure appeared to be improved in patients treated with ATDA when compared with expected outcomes. Owing to small sample size, differences in initial defect size, and variety of body locations, the wound closure rate between treatment groups was not found to be significantly different with most comparisons. Statistical significance was seen, however, when normalized closure rates between membrane and control intervention were compared after outlier analysis (P = .0288).

Conclusions: Data indicate that ATDA treatment may be beneficial and suggest that further investigation of the efficacy of ATDA to promote wound healing and improve cosmetic outcomes of post-Mohs surgical wounds is warranted. Future studies should be designed to match initial defect size and location between control and treatment groups.

Introduction

After skin cancers are removed by Mohs micrographic surgery, wounds in locations such as pretibial skin, lower extremities, scalp, conchae, and digits are typically left open and may require several weeks to close, potentially necessitate multiple follow-up visits, and can carry a significant risk of infection. This study investigated the effectiveness of amniotic tissue–derived allograft (ATDA) to improve outcomes in post-Mohs wound care in areas where wound closure is difficult, focusing on time to wound closure and assessment of cosmetic outcomes.

Amniotic tissue–derived allograft has been shown to improve wound healing in a variety of clinical settings. Numerous studies have documented the effectiveness of ATDA in improving wound healing in diabetic foot wounds refractory to standard treatment modalities.[1–15] Although previous studies have demonstrated that weekly applications of membrane over the wound area have resulted in increased rates of wound healing,[1,2,11,15–17] the properties of amniotic fluid have been less well studied.

Preparations of ATDA have been shown to contain cytokines, growth factors, protease inhibitors, angiogenin, and extracellular matrix (ECM) components, which are extracted from the fluid and released from the membrane to the wound, promoting cell proliferation and migration in vitro.[18–21] In addition, as a scaffold rich in ECM, amniotic membrane has been shown to effectively bind a variety of cell types,[20,22–24] is thought to mobilize endogenous growth factors and cytokines,[20,25,26] and appears to increase host cell infiltration.[26–28] Thus, the suspected mode of action of wound healing is to release growth factors and cytokines,[18–21] attracting stem cells and promoting both angiogenesis and stem cell differentiation.[20,25,26,28]

A preliminary case series suggests that the use of dehydrated amnion/chorion membrane allograft has shown efficacy in full-thickness defects after Mohs micrographic surgery;[16] however, to the authors' knowledge, the efficacy of this allograft in secondary intention wound healing has not been systematically investigated. If beneficial effects can be demonstrated in the post-Mohs setting, improved patient outcomes may include decreased time to wound closure and decreased postoperative complications. Benefits to the health care system may include a decreased need for skin grafts, decreased number of postoperative visits, and an overall reduction in health care costs.

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