The Use of Human Amniotic Chorion Membrane Allograft for Complex Hand Reconstruction and Limb SalvageSom Kohanzadeh, MD, Director of Amputation Prevention Center, Director of Plastic Surgery; Samantha Scigliuto, PA-C; David Pougatsch, DPM

Sherman Oaks Hospital, Sherman Oaks, CA

SAWC Fall Meeting, September 26-28, 2015 in Las Vegas, NV

Cases

Purpose

Methods

Background

Results

Conclusions

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2015 Mar;24(3):104; 106-9; 111.8. Zelen CM, Gould L, Serena TE, Carter MJ, Keller J, Li WW. A prospective, randomised, controlled, multi-centre comparative effectiveness study of healing using

dehydrated human amnion/chorion membrane allograft, bioengineered skin substitute or standard of care for treatment of chronic lower extremity diabetic ulcers. Int Wound J. 2014 Nov 26. [Epub ahead of print]

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Soft tissue coverage in hand injuries is a problem because of underlying structures:bone, tendon, nerve or vessels and often requires loco-regional or free flapreconstruction which is costly with long operative times and postoperative care, aswell as significant donor morbidity.

Dehydrated Human Amnion/Chorion Membrane (dHACM) Dehydrated human amnion/chorion membrane (dHACM) contains an array of

growth factors known to play critical roles in the physiological processes of normalhealing and tissue regeneration.

The use of dHACM allograft allows us to provide coverage of these vital structureswithout the need for flap reconstruction.

Randomized controlled trials and clinical studies have shown dHACM allografts to beeffective in the treatment of many types of wounds.

We conducted a retrospective review of 3 patients undergoing the usage of dHACMfor soft tissue coverage of the hand.

All patients provided consent for treatment and the use of their personal healthinformation.

To describe the use of dHACM allografts in 3 patients treated for complex handreconstruction.

All patients suffered injuries resulting in complex soft tissue defects, 2 were severediabetics with peripheral vascular disease and one had severe crush injury.

After the use of dHACM, none went on to require flaps or local tissuerearrangement, or skin graft.

Follow-up ranged from 2-6 months. Complications included partial wound closure, which was then treated with local

wound care. There was no incidence of hematoma, seroma or infection. All patients went on to physical therapy and regained use of their hands.

dHACM can serve as a bridging method, but sometimes even as an alternative to morecomplex reconstructive cases in the hand, and in particular may be useful in limb or fingersalvage in the case of the hand.

This is helpful because it saves patients from long anesthetic times, extensive postoperativewound care (as in the case of abdominal or groin flaps), and saves precious soft tissue foralternative use in poly-trauma patients.

Treatment with dHACM can save patients’ from significant psychologic trauma ofamputation and its associated functional loss.

dHACM = EpiFix®, MiMedx Group, Inc., Marietta, GA EpiFix® and PURION® are registered trademarks of MiMedx Group, Inc.

Case 1 – Dog bite. Fifth finger right hand.

Treatment day 0 Day 8 Day 15 Healed

Case 2 – Osteomyelitis.

Day 0 Day 7 Day 28

Case 3 - Finger salvage.

Treatment day 0 Day 6 Day 39