title: Dehydrated Human Amnion/Chorion Grafts May Accelerate the Healing of Ulcers on Free Flaps in Patients With Venous Insufficiency and/or Lymphedema.
abstract: OBJECTIVE
  Ulceration of free flaps in patients with venous insufficiency and/or lymphedema is an uncommon but challenging problem. We hypothesized that dehydrated human amnion/chorion membrane (Epifix) grafts would accelerate healing of these challenging ulcers.
  
  
  METHODS
  Retrospective analysis of prospectively acquired data identified 8 lower extremity free flaps with ulcerations in the context of venous insufficiency and/or lymphedema. The first 4 were flaps that had been treated with conservative wound care to healing. The second group was treated conservatively initially but then converted to treatment with dehydrated human amnion/chorion membrane grafts. The primary endpoint was time to healing.
  
  
  RESULTS
  Comparison of Kaplan-Meier survival curves revealed a significant difference between the conservatively and dehydrated human amnion/chorion membrane-treated flap ulcers, favoring graft treatment (P = .0361). In those ulcers that healed, the average time to healing was 87 days for the conservative treatment group and 33 days for the dehydrated human amnion/chorion membrane treatment group (with an average of 1.7 grafts per ulcer).
  
  
  CONCLUSIONS
  Dehydrated human amnion/chorion membrane may accelerate healing of ulcers on lower extremity free flaps in patient with lymphedema and/or venous disease in the treated leg.
authors.affiliation: Center for Complex Reconstruction, San Francisco, Calif; Department of Plastic Surgery, California Pacific Medical Center, San Francisco.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Miranda
authors.affiliation: Center for Complex Reconstruction, San Francisco, Calif.
authors.forename: Alex
authors.initials: A
authors.lastname: Friedman
keywords: amnion/chorion; free flap; lymphedema; microsurgery; venous ulcer