title: Amniotic membrane transplantation in the treatment of chronic lower limb ulcers.
abstract: BACKGROUND
  Approximately 1% of the general population have venous or arterial lower limb ulcers. These lesions can be treated with biological skin substitutes such as cadaver skin or tissue-engineered skin equivalents, but treatment fails in 25% of cases, resulting in pain and loss of patient autonomy, as well as increased morbidity and health care costs. In the treatment of corneal ulcers, amniotic membrane has been shown to have antimicrobial and bacteriostatic properties, and to protect the wound without eliciting an immune response. The same properties have been reported in the treatment of burns and postthrombotic ulcers.
  
  
  OBJECTIVE
  To assess the effectiveness of amniotic membrane transplantation in the treatment of refractory chronic leg ulcers.
  
  
  METHODS
  Amniotic membrane was grafted onto 4 refractory ulcers in 3 patients. The mean time required for partial and complete re-epithelialization was calculated by measuring the wound area at weeks 0, 4, 8, 12, and 16. Pain intensity was assessed at the same intervals using a visual analog scale.
  
  
  RESULTS
  Complete wound re-epithelialization was achieved for 1 ulcer by week 8; in the other 3 cases, there was a 50% reduction in size compared to baseline. At week 16, the mean reduction in wound size for the 4 ulcers was 81.93%. The corresponding reduction in pain intensity was 86.6%. No adverse effects were observed.
  
  
  CONCLUSIONS
  Amniotic membrane transplantation might be an effective alternative for the treatment of refractory chronic vascular ulcers on the lower limbs.
authors.affiliation: Servicio de Dermatología, Hospital Clínic, Transplant Services Foundation, Universitat de Barcelona, Barcelona, Spain. malsina@clinic.ub.es
authors.forename: M
authors.initials: M
authors.lastname: Alsina-Gibert
authors.forename: S
authors.initials: S
authors.lastname: Pedregosa-Fauste
mesh_terms: D000368:Aged; D001684:Biological Dressings / Q000191:economics; D003646:Debridement; D006801:Humans; D007871:Leg Ulcer / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D010147:Pain Measurement; D016896:Treatment Outcome; D014945:Wound Healing