A novel use of amniotic bilayer dressing co-cultured with keratinocytes and stem cell as skin substitute in adult burn patients.

Survival outcome of burn patients is increasingly higher with early excision and grafting. The problem after excisional debridement is the need for a skin graft or a temporary dressing. By using an amniotic membrane, which is a biological waste, we can limit the use of auto-skin grafts. A preliminary prospective study was conducted on adult patients with no other comorbidities admitted to dr. Cipto Mangunkusumo Hospital Jakarta Burn Unit between 2021-2022. Patients were divided into three groups, treated with early excision and skin grafting, the amnion bilayer dressing or amniotic bilayer dressings co-cultured with keratinocytes and human amniotic epithelial stem cells (hAESC). The patients were then followed up for two weeks and the resulting epithelization in each group was analyzed, including a skin biopsy for confirmation of the epidermal layer thickness. A total of six patients, two in each group, were included in the study. The amniotic bilayer dressings co-cultured with keratinocytes and stem cell group has a rapid rate of epithelization (10% / day) compared to the early excision and skin grafting and amnion bilayer group (7.14% / day). It also has the thickest epidermal layer (95.7μm - range: 67.4-124.02 μm) and the highest histological score (7.00) at two weeks follow-up. This preliminary study concluded that amniotic bilayer dressings co-cultured with keratinocytes and stem cells had an overall better outcome regarding epithelization rate, suggesting that further study is necessary to evaluate amniotic bilayer dressings co-cultured with keratinocytes and stem cell use in burn patients.