Clinical Trial – Use of equine amnion wound dressing (eAM) as source of extracellular matrix to heal distal limb wounds in horses
Barcelo-Fimbres M – Anicell Biotech LLC, Chandler, AZ, USA, Schnabel LV – North Carolina State University, NC, USA, Sorum M – Scottsdale Horse Vet, AZ, USA, Campos-Chillon LF – Cal Poly San Luis Obispo, CA, USA, Culp A – Anicell Biotech LLC, Chandler, AZ, Rivera R – Universidad Autonoma de Ciudad Juarez, Chih, Mex.
Introduction:
Wound healing is difficult when large areas are involved, but even harder for distal limbs where poor blood circulation, minimal soft tissue between skin and bone and/or joint movement are present. Management of large wounds under standard care treatment might take months or even years to heal and requires second intention healing specially in distal limbs which most of the times results in very slow healing, scar tissue formation and a bad functional and cosmetic result. For example, wounds at flank region epithelialize at a rate of 0.2 vs. 0.09 mm/day for wounds in the distal limbs (1). For this reason, the clinical use of sterilize, dehydrated, treated and preserved Equine Amnion Wound Dressing is used as a bioscaffold.
Amniotic membrane contains all the basic building blocks of extracellular matrix and has been previously used as an occlusive biological dressing on fullthickness wounds in canines (2) and humans to treat diabetic ulcers (3), demonstrating excellent results in wound contraction and closure. Acellular wound dressing which appear to stimulate and create extracellular matrix for increased rates of epithelialization.
Objectives/hypothesis:
The aim of this clinical study was to evaluate wound contraction rates using equine amnion wound dressing (eAM). We hypothesized that eAM will speed wound contraction rate of full thickness wounds in distal limbs of horses.
Materials and Methods:
Fifteen clinical cases were evaluated for 60 days; control (n=4) were treated by standard care (cleaning, lavaging, debridement, and banding) and eleven eAM (StemWrapÒ membrane/2 mL StemWrapÒ+ injection; AniCell Biotech, AZ). Wound area (WA) was analyzed using Image J software based on pixes/mm. Wound contraction rate (WCR) was (Initial WA (day 0) minus WA at given day)/initial WA x 100. Wound daily contraction (WDC) was millimeters2/day of WA covered up to day 20 and 60. WDC was analyzed by ANOVA and WCR by regression model included linear and quadratic terms and dummy variables were used for categorical variables, using SAS software. (101/100).
Results:
No allergic reactions were observed using eAM. A higher WDC was observed at 20, 60 and all 60 days for eAM vs. Control (0.8 vs. 2.4, 0.6 vs. 1.8, and 0.7 vs. 2.2 mm2/day, respectively; all P<0.001).
Also, a faster WCR for eAM than control was observed. It is to be noted that the healing profile slopes were different with the control showing a more lineal distribution and more of a quadratic distribution for eAM. Based on the regression equations, at 20 days there was a 3.4x increase in contraction rate and 2x improvement compared to the control at day 60, 47.3 vs. 13.8 WCR% at 20 days and 84.2 vs. 41.3 WCR% at 60 days respectively.
Conclusions: The use of Equine Amniotic Material as biological dressing proved to be a safe, and have a 1x higher wound contraction rate and closure per day (3.1x) than that of the control at 60 days on full thickness wounds in distal limbs of horses.
References: (1) Stashak TS: Principles of wound healing. In TS Stashak ed. Equine wound management. Philadelphia: Lea and Febiger, 1991, p. 11 (2) Ramsey DT, et al., 1995. American Journal of Veterinary Research, 56(7):941-949. (3) Werber B, Martin E. 2013. J Foot Ankle Surg. 52(5):615-21.
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