Clinical Applications

• Wound care/burns (12-18)
• Spine/neurologic surgeries (23-29)
• Podiatric surgery (11)
• Ophthalmic procedures (8-10,33,34,37-40)
• Cranio Maxillofacial surgery (23)
• Urology (7)
• Ob Gyn (6, 42, 43)
• Trauma (6, 23-29)
• Dental
• Bariatric surgeries (2)
• Sports medicine (19-21)
• Cosmetic (11)

Outcomes

• Prevent adhesions tethered to implant hardware (27, 29)
• Prevent adhesions in tendon grafts and repair (18, 20-22)
• Inhibit brogenesis (scarring) when applied topically to dermal and subcutaneous wounds (12-18, 32-36)
• Reduce occurrence of dural and nerve root adhesions (2, 22, 32-36)

Benefits and Advantages

Research has shown the healing power of Amnion

Amnion, the inner most layer of the placental tissue surrounds and protects the fetus during development in utero. Its properties that bene t the fetus also makes it an effective tissue for protecting a wide variety of wounds, while at the same time creating an environment conductive to the regeneration of healthy tissue.

Benefits

• Non Immunogenic (30,31)
• Safe, natural covering that improves normal wound healing outcomes (2-6, 45-49)
• Provides a substrate for stem cells (2, 5, 48)
• Anti-Adhesive (2, 32-36)
• Anti-Microbial (41-44)
• Reduces Pain (1)
• Reduces Inflammation (35-40)
• Reduces Fibrosis and Scaring (2, 32-36)

Advantages

• Single layer
• Stromal or Epithelial side can be used
• Can be applied dry, hydrates rapidly in wound environment
• Can be applied wet, hydrate using normal saline, blood or similar solution prior
• Not chemically cross-linked
• Readily adheres to the tissue or wound surface
• Ambient temperature storage
• Can be sutured to prevent migration
• 3 year shelf life from date of packaging
• Proprietary validated viral inactivation process

Safety

Recovery and Processing

• Donor tissue collected in an aseptic manner by registered tissue procurement organizations
• Placentas from planned C-sections minimize the potential for contamination during recovery
• Placental donors go through a rigorous pre-screening quali cation in accordance with the U.S. Food and Drug Administration (FDA)
• Processed in accordance with the safety guide-lines provided by the FDA
• Sterilized by Gamma Irradiation to SAL 10-6 in accordance with ISO 11137
• Amnion is regulated as a Human Cellular and Tissue based Products (HCTP) (21 CFR Part 1271) and in accordance with the standards set forth by the American Association of Tissue Banks (AATB)

References

1. Jay RM. Initial Clinical Experience with Use of Human Amniotic Membrane Tissue During Repair of Posterior Tibial and Achilles Tendons. 2009.
2. Niknejad H et al. Properties of the Amniotic Membrane for Potential Use in Tissue Engineering. European Cells and Materials. 2008; 15:88-99.
3. Davis J. Skin Transplantation: With a review of 550 cases at John Hopkins Hospital. John Hopkins Hosp Rep. 1910; 15:310.
4. Stern M. The Grafting of Preserved Amniotic Membrane to Burned and Ulcerated Surfaces Substituting Skin Grafts. J Amer Med Assoc. 1913; 60:973-974.
5. Toda A et al. The Potential of Amniotic Membrane/Amnion-Derived Cells for Regeneration of Various Tissues. J Pharmacol Sci. 2007; 105:215-228.
6. Trelford JD and Trelford-Sauder M. The Amnion in Surgery, Past and Present. Am J Obstet Gynecol. 1979; 134:833-845.
7. Di Loreto FP et al. Dried Human Amniotic Membrane as an Anti-adherent Layer for Intraperitoneal Placing of Polypropylene Mesh in Rats. Surg Endosc. 2013; 27:1435-1440.
8. DeRott A. Plastic Repair of Conjunctival Defects with Fetal Membranes. Arch Ophthalmol. 1940; 23:522-555.
9. Kheirkhah A et al. Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell De ciency. Am J Ophthalmol. 2008; 145:787-794.
10. Liu J et al. Update on Amniotic Membrane Transplantation. Expert Rev Ophthalmol. 2010; 5:645-661.
11. Fairbairn NG et al. The Clinical Application of Human Amnion in Plastic Surgery. J Plast Recon Aesthet Surg. 2014; 67:662-675.
12. Kesting MR et al. The Role of Allogenic Amniotic Membrane in Burn Treatment. J Burn Care Res. 2008;29:907-916.
13. Sabella N. Use of Fetal Membranes in Skin Grafting. Med Records NY. 1913; 83:478-480.
14. Sorsby A and Symons HM. Amniotic Membrane Grafts in Caustic Burns of the Eye. Br J Ophthalmol. 1946; 30:337-345.
15. Bujang-Safawi E et al. Dried Irradiated Human Amniotic Membrane as a Biological Dressing for Facial Burns- a 7-Year Case Series. Burns. 2010; 36:876-882.
16. Walker AB et al. Use of Fresh Amnion as a Burn Dressing. J Pediatr Surg. 1977; 12:391-395.
17. Mohammadi AA et al. Effect of Fresh Human Amniotic Membrane Dressing on Graft Take in Patients with Chronic Burn Wounds compared with Conventional Methods. Burns. 2013; 39:349-353.
18. Mohammadi AA et al. Effect of Amniotic Membrane on Graft Take in Extremity Burns. Burns. 2013; 39:1137-1141.
19. Jin CZ et al. Human Amniotic Membrane as a Delivery Matrix for Articular Cartilage Repair. Tissue Eng. 2007; 13:693-702.
20. Yang JJ et al. The Effect of Amniotic Membrane Transplantation on Tendon-Healing in a Rabbit Achilles Tendon Model. Tissue Eng and Regen Med. 2010; 7:323-329.
21. Demirkan F et al. The use of amniotic membrane in exor tendon repair: an experimental model. Arch Orthop Trauma Surg. 2002; 122:396-399
22. Jay RM et al. A Retrospective Study of Tendon Adhesions following Surgical Repair of Peroneal and Posterior Tibial Tendons with Amniotic Membrane. J Foot Ankle Surg. 2012.
23. Chao YC et al. A New Method of Preventing Adhesions – The Use of Amnioplastin after Craniotomy. British Medi- cal Journal. 1940; 1:517-538.
24. Mohammad J et al. Modulation of Peripheral Nerve Regeneration: a Tissue-Engineered Approach. The Role of Amnion Tube Nerve Conduit across a 1-Centimeter Nerve gap. Plast Reconstr Surg. 2000; 105:660-666.
25. Mligiliche N et al. Extracellular Matrix of Human Amnion Manufactured into Tubes as Conduits for Peripheral Nerve Regeneration. J Biomed Mater Res. 2002; 63:591-600.
26. Sankar V and Muthusamy R. Role of Human Amniotic Epithelial Cell Transplantation in Spinal Cord Injury Repair Research. Neuroscience. 2003; 118:11-17.
27. Tao H and Fan H. Implantation of Amniotic Membrane to Reduce Post-laminectomy Epidural Adhesions. Eur Spine J. 2009; 18:1202-1212.
28. Meng H et al. Assessment of Processed Human Amniotic Membrane as a Protective Barrier in Rat Model of Sciatic Nerve Injury. Neuroscience Letters. 2011; 496:48-53.
29. Goldschlager T et al. A Comparison of Mesenchymal Precursor Cells and Amnion Epithelial Cells for Enhancing Cervical Interbody Fusion in an Ovine Model. Neurosurgery. 2011; 68:1025-1035.
30. Szerekes-Bartho J. Immunological Relationship between the Mother and the Fetus. Int Rev Immunol. 2002; 21:471-495.
31. Ueta M et al. Immunosuppressive Properties of Human Amniotic Membrane for Mixed Lymphocyte Reaction. Clin Exp Immunol. 2002; 129:464-470.
32. Veenstra van Nieuwenhoven AL et al. The Immunology of Successful Pregnancy. Human Reproduction Update. 2003; 9: 347-357.
33. Lee SB et al. Suppression of TGF-beta Signaling in both Normal Conjunctival Fibroblasts and Pterygial Body Fibroblasts by Amniotic Membrane. Curr Eye Res. 2000; 20: 325-334.
34. Tseng SC, et al. Suppression of TGF-b Isoforms, TGF-b Receptor Type II and Myo broblast Differentiation in Cultured Human Corneal and Limbal Fibroblast by Amniotic Membrane Matrix. J Cell Physiol. 1999; 179:325-335.
35. Lin ZQ et al. Essential Involvement of IL-6 in the Skin Wound-healing Process as Evidenced by Delayed Wound Healing in IL-6-de cient Mice. J Leukoc Biol. 2003; 73:713-721.
36. Kieran I et al. Interleukin-10 Reduces Scar Formation in both Animal and Human Cutaneous Wounds: Results of Two Preclinical and Phase II Randomized Control Studies. Wound Repair Regen. 2013; 21:428-436.
37. Tseng SC. Amniotic Membrane Transplantation for Ocular Surface Reconstruction. Bioscience Reports. 2001; 21:481-489.
38. Solomon A et al. Suppression of Interleukin-1alpha and Interleukin-1beta in Human Limbal Epithelial Cells Cultured on the Amniotic Membrane Stromal Matrix. Br J Ophthalmol. 2001; 85: 444-449.
39. Solomon A et al. Suppression of in ammatory and brotic responses in allergic inflammation by the amniotic membrane stromal matrix. Clin Exp Allergy. 2005; 35:941-948.
40. Higa K et al. Hyaluronic Acid-CD44 Interaction Mediates the Adhesion of Lymphocytes by Amniotic Membrane Stroma. Cornea. 2005: 24:206-212.
41. Talmi YP et al. Antibacterial Properties of Human Amniotic Membranes. Placenta. 1991; 12:285-288.
42. Kjaergaard N et al. Antibacterial Properties of Human Amnion and Chorion in vitro. Eur J Obstet Gynecol Reprod Biol. 2000; 94:224-229.
43. Stock SJ et al. Natural Antimicrobial Production by the Amnion. Am J Obst Gynecol. 2007; 196:255. e1-6.
44. King AE et al. Expression of Natural Antimicrobials by Human Placenta and Fetal Membranes. Placenta 2007; 28: 161-169.
45. Blumenfeld I et al. Annals of Burns and Fire Disasters-Vol. XIII, No. 4 - Dec 2000.
46. Adler SC and Kent KJ. Enhancing Wound Healing with Growth Factors. Facial Plast Surg Clin North Am. 2002; 10:129-146.
47. Wang L et al. Epidermal Growth Factor (EGF)-induced Corneal Epithelial Wound Healing through Nuclear Factor-kB Subtype-Regulated CCCTC Binding Factor (CTCF) Activation. J Biol Chem. 2013; 288:24363-24371.
48. Schneider L et al. Directional Cell Migration and Chemotaxis in Wound Healing Response to PDGF-AA are Coordinated by the Primary Cilium in Fibroblasts. Cell Physiol Biochem. 2010; 25:279–292.
49. Jiang B et al. Dual Delivery of Chlorhexidine and Platelet-Derived Growth Factor-BB for Enhanced Wound Healing and Infection Control. Acta Biomater. 2013; 9:4976-4984. v

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