Addressing Natural Wound Closure and Reducing Fibrosis with Human Dehydrated Amniotic Particulate Allografts*

Abstract

Ensuring wound closure and minimizing fibrosis can be challenging after surgical procedures such as abdominal wall reconstruction with panniculectomy after weight loss. This is true, especially, with the fleur-de-lis pattern involving a resultant transverse and vertical patient scar.1 These procedures require extensive tissue dissection in order to reconstruct fascial defects as well as to release tissue for excision and contouring.2 This study presents two cases using dehydrated human amniotic particulate allograft (dHAPA) tissue placed in the deep soft tissue prior to wound closure to address inflammation and fibrosis around the incisional wound.

Case 1 is a 42 year-old female who underwent vertical band gastroplasty for weight loss. She lost over 100 pounds that exposed underlying hernias. Fascial repair was performed with component separation technique in addition to mesh repair. A fleur-de-lis skin excision was performed with closure of Scarpa’s fascia. dHAPA was applied above this layer according to wet application proto-cols in the deep subcutaneous tissue, prior to further layered closure in deep dermis and sub-cuticular planes. Drains were re-moved one week post-operative. Two weeks later, the patient presented with remarkable decreased swelling and inflammation as compared to cohorts without dHAPA.

Case 2 is a 69 year-old female who underwent gastric bypass procedure losing 80 pounds. After this procedure, she developed small bowel obstruction and hernia resulting in mesh placement. After convalescence, the patient presented with significant excess skin and underwent a fleur-de-lis skin excision and closure with dHAPA. In addition to incisional placement of dHAPA, it was placed atop the prior mesh placement to potentially minimize fibrosis. There was reduced inflammation around the wound at two weeks, with continued improvement at 6 months and decreased contracture around palpable mesh. The observed reduction of fibrosis and contractures may demonstrate the potential role of dHAPA (due to the preserved inherent characteristics native to the tissue) in assisting incisional wound management cases, while supporting natural wound closure.

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