title: Case report of non-healing surgical wound treated with dehydrated human amniotic membrane.
abstract: BACKGROUND
  Non-healing wounds can pose a medical challenge as in the case of vasculopathic venostasis resulting in a surgical ulcer. When traditional approaches to wound care fail, an amniotic patch (a dehydrated tissue allograft derived from human amnion) can function as a biologic scaffold to facilitate and enhance tissue regeneration and rehabilitation.
  
  
  BACKGROUND
  Amniotic AlphaPatches contain concentrated molecules of PGE2, WNT4, and GDF-11 which have angiogenic, trophic, and anti-inflammatory effects on tissues that may be useful in enhancing wound healing.
  We present a case of a severe non-healing surgical wound in a 78-year-old male 17 days post right total knee arthroplasty. The full-thickness wound exhibited a mobile flap, measured 4 cm long × 3 cm wide, and showed undermining down to patellar tissue. We treated the wound conservatively for 6 weeks with no evidence of wound healing. Upon failure of the conservative treatment, two amniotic AlphaPatch (Amniotic Therapies, Dallas, TX, USA) were applied to the wound, and the wound healed completely in 10 weeks.
  
  
  METHODS
  In the OR, the wound was irrigated with three liters of double antibiotic solution under pulse lavage. Two dry amniotic AlphaPatch (4 cm × 4 cm) were placed over the wound with Acticoat applied on top.
  
  
  RESULTS
  At the two-week follow-up visit (following the incision and drainage of the wound dehiscence and application of the amniotic AlphaPatch), a central scab had formed centrally in the wound dehiscence area. At the four-week follow-up visit, the wound dehiscence area had completely scabbed over with no open areas left. At the eight-week follow-up visit, the scab had just fallen off, and the wound was healing well with immature skin representing the size of a penny. At the ten-week follow-up visit, the wound was completely healed.
  
  
  CONCLUSIONS
  Sterile, dehydrated amniotic tissue AlphaPatches (containing trophic factors known to enhance wound healing) have proven effective in completely healing an otherwise non-healing wound in a 78-year-old male who failed six weeks of conservative wound care treatment.
authors.affiliation: MediStem Panama Inc., City of Knowledge, Panama City, Republic of Panama. nhriordan@gmail.com.|Riordan-McKenna Institute, 801 E. Southlake Blvd., Southlake, TX, 76092, USA. nhriordan@gmail.com.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Riordan
authors.affiliation: Riordan-McKenna Institute, 801 E. Southlake Blvd., Southlake, TX, 76092, USA. ben@lonestarsurgicalgroup.com.
authors.forename: Ben A
authors.initials: BA
authors.lastname: George
authors.affiliation: Riordan-McKenna Institute, 801 E. Southlake Blvd., Southlake, TX, 76092, USA. troy@rmiclinic.com.
authors.forename: Troy B
authors.initials: TB
authors.lastname: Chandler
authors.affiliation: Riordan-McKenna Institute, 801 E. Southlake Blvd., Southlake, TX, 76092, USA. drmckenna@rmiclinic.com.
authors.forename: Randall W
authors.initials: RW
authors.lastname: McKenna
mesh_terms: D000368:Aged; D000650:Amnion / Q000637:transplantation*; D003890:Desiccation; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013529:Surgical Wound Dehiscence / Q000628:therapy*; D007507:Therapeutic Irrigation; D014945:Wound Healing