Burn is a common traumatic injury that causes significant disability and mortality. In addition of long hospitalization and rehabilitation, as well as the cost of treating wound burns and scars is one of the most costly traumatic injuries.
The number of people who need medical care around the world due to burns is estimated approximately 6 million person. Severe burns are usually associated with loss of skin connective tissue, severe dehydration, high level of inflammatory cytokines, colonization of microorganism, tissue vessels loss, and extensive cell damage that can interfere with the process of burn wound healing.
In the past decades, many of the materials have been used to treat wound burns including allogenic skin replacement, epidermal or dermal allogenic cultured cells.
Recently. Stem cells and tissue engineering have been used as new therapies for repairing damaged skin. In addition of differentiation of stem cells into endothelial and epithelial cells, these cells have also affect cytokines and growth factors in body.
Since 1910, amniotic membrane has been the first bio scaffold that has been widely used in wound healing. Many studies have shown the effectiveness of amniotic membrane in wound healing due to biological and mechanical properties. These properties provide an appropriate environment for cell proliferation and migration, the formation of granulation tissue and remodeling of the extracellular matrix.
In this study, 10 patients with 10-30% of burn severity have been admitted in the Royan institute during 1393-1395 in both genders.
Burn severity 10-30%
Patients who suffering from electrical burns
Fourth degree burn
Burn with multiple injuries (patients with fractures or damage to the central nervous system, chest and abdominal trauma)
Elderly people with underlying illness such as chronic cardiovascular disease, diabetes or high blood pressure.
An amniotic membrane or amniotic with embryonic fibroblasts was used to cover the site of the lesion.
In this study 10 patients with 10-30% burn severity were treated with amniotic membrane stem cell therapy. The skin of the patients is divided to 3 parts 5×5 cm.
They were randomly coated with Vaseline gas, amniotic membrane, amniotic membrane and embryonic fibroblasts. The rate of wound healing, pain severity, an infection at the site were evaluated by an independent burner surgeon on days 4,8,11, 15 and six months after treatment. The severity of pain in the treatment areas was graded from 0-10 by the patient. 3 biopsy punches were taken on the 12th day after surgery and examined pathologically.
In this study, the natural process of wound healing was observed in the specimens. After three weeks, all wounds were fully restored in all groups and showed rupitalisation. The repair speed was in the amniotic membrane with embryonic fibroblasts. Compared to the group that received the amniotic membrane a
The repair speed of amniotic membrane and embryonic fibroblast was more than other groups which received just Vaseline gas or amniotic membrane. The first group reported less pain during the follow- up period.
Histological evaluation of biopsy specimens showed that the damaged skin from burn was repaired in all three groups. Although the rupitalisation in two groups (Amniotic membrane and cell, just amniotic membrane) was higher than the control group, but this difference was not significantly. In addition, in the first group which received amniotic membrane and embryonic fibroblasts, there was less inflammation and fibrosis rather than amniotic membrane group or control group.
Image- Wound healing and pain intensity decreasing in treatment groups over time!
Epidermolysis Blouse (EB):
Epidermolysis Blouse (EB) is a hereditary disorder which characterized by blister appearing on the surface of the skin and mucous membranes after mechanical stimulation. To overall prevalence of EB is estimated to 8-10 per million births. The complications of this disease are including severe anemia, growth distributions in children, esophageal structure, deformity of the hands and feet, glomerulonephritis and subsequent chronic renal failure and many other things. One of the most common side effects of this disease is Squamous Cell Carcinoma (SCC) which is rapidly growing and spreading.
In this study, 15 EB patients have been admitted from 1391-1393 in the Royan Institute.
1- Ranging in age more than 1 year in both of gender
2- Clinical or microscopic diagnosis of EB
3- Chronic resistance wound to treatment
1- Pregnancy and breastfeeding
2- Immunodeficiency diseases
3- Evidence of infection in transplantation
4- Severe anemia
5- Viral infection
Patients were treated with amniotic membrane, autologous fibroblast cultivated on amniotic membrane or allogenic fibroblast cultivated on amniotic membrane.
First, the patients may be needed to separate their fingers under surgical. Then, they were randomly divided into three groups, the patients were received amniotic membrane, the patients who received autologous fibroblast cultivated on amniotic membrane and the patients who received allogenic fibroblasts cultivated on amniotic membrane. Autologous fibroblasts were provided by the punch biopsy of the back of the ear and allogenic fibroblasts were provided from the cell bank of the Royan Institute. 5-8 million of fibroblast cells were placed on an amniotic membrane of 10× 10 cm and transplanted to patient’s hands. Histological examination was performed in 3,6,12 months after treatment and recoded.
All of patients who entered in study were underwent surgery and follow-up. The range of patient’s age were 2-22 years and 9 patients (60%) were male. All of parent’s patients had family marriage. Five patients had history of previous surgery. No serious side effects were reported during the intervention and follow up of patients. The results have been demonstrated that the group of patients who received allogenic fibroblasts has more survived graft in 6 and 12 months after transplantation. The mitten hand recurrence occurred 9-11 months after transplantation. While recurrence occurred within 5-7 months after transplantation in the group receiving amniotic membrane of autologous fibroblast.
Histological evaluation demonstrated collagen production in all groups that were degraded in autologous fibroblast and allogenic fibroblast groups within 3-6 months after transplantation, respectively.