Inhsan Oesman and colleagues from the Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine of Universitas Indonesia, Indonesia recently reported an interesting find where Gamma-treated placental amniotic membrane allograft was used as the adjuvant treatment of unresponsive diabetic ulcer of the foot.
This study is published in the International Journal of Surgery Case Reports
Placental amniotic membranes are composed of cells, extra-cellular matrix (ECM), and a complex of regulatory cytokines which promote cell proliferation, cell modulation, and cytokine secretion by variety of cell types involved in wound healing.
However, diabetic ulcer of the foot is a major cause of morbidity and is a leading cause of hospitalization in patients with diabetes, and causes productivity and financial losses that lower the quality of life of the patient. The wound is categorized as responsive and unresponsive wound, which occurs in debilitated patients as seen in diabetes mellitus. Unresponsive diabetic ulcer is ulcer that does not reduce in size within a month. The delay in wound repair can be caused by senescent cells, absence of growth factors, and other cellular abnormalities.
Therefore, the authors studied a retrospective, single-center case series with non-consecutive cases. Patients with diabetic ulcer of the foot managed using gamma-treated placental amniotic membrane, with the minimum follow up of 1 month in academic practice setting were included in the data.
Three patients with 4 weeks period of oozing ulcers and signs of inflammation were included in this case series. Two layers of amniotic membrane dressing was applied weekly after cleaning and debridement for 3 weeks. Wound size and secretion were documented by taking photographs every week. At the end of the third week, complete wound healing was observed, revealed Oesman.
Our study showed that the treatment of diabetic ulcer wound using amniotic membrane was successful in achieving wound healing in unresponsive, chronic wound of diabetic ulcer of the foot, he further added.
As a result, the authors concluded that "the application of amniotic membranes in treatment of diabetic ulcer of the foot is useful. Amniotic membrane favored healing of unresponsive and non-healing ulcers."