Rescue treatment with intravenous immunoglobulin and amniotic membrane dressing in refractory paediatric pemphigus vulgaris with sepsis.

We report a case of refractory paediatric pemphigus vulgaris with sepsis, treated successfully with intravenous immunoglobulin (IVIG) and amniotic membrane dressing. The patient was initially started on oral prednisolone (1 mg/kg/day) and dapsone 50 mg once daily. Azathioprine 50 mg orally was then used in place of dapsone due to rapid disease progression with extensive skin involvement. However, the patient developed sepsis and azathioprine had to be discontinued. Because of rapidly progressive disease and sepsis, the patient was put on IVIG at a dose of 2 g/kg in divided doses over 3 days along with amniotic membrane dressing. There was marked improvement after 2 weeks of follow-up.

A pilot study of the use of human amniotic membrane as subcutaneous implants in a mouse model: a potential for temporary substitutes in two-stage breast reconstructions.

INTRODUCTION: Breast reconstruction by prosthesis is frequently performed in breast cancer treatments, and a temporary substitute is used in the first step of two-stage operations. AIM: Due to the advantageous biological features of the human amniotic membrane, we aimed to evaluate its use for temporary implants. METHOD: We prepared small spherical implants from human amniotic membranes and inserted them into BALB/c mice's subcutaneous flanks. Then, we compared the bulging they produced, the durability, and the host reaction with implants made from the chorionic membrane, folded membrane patches, and sterile plastic beads. RESULTS: All amionitic cases were healthy throughout the study and only mild inflammation occurred in them. Furthermore, the bulging of the implants was acceptable and faded gradually. However, moderate inflammation was observed in chorionic implant mice, and the bulging disappeared very soon. Finally, the control group had severe inflammation and the beads implant was rejected. CONCLUSION: Our study showed that the human amniotic membrane could represent a safe and valid tool for breast reconstruction, however, further studies on larger animals and more implants are suggested.

Hyperdry Human Amniotic Membrane as a Protective Dressing for Open Wounds With Exposed Bowel in Mice.

INTRODUCTION: An enteroatmospheric fistula forms when the exposed bowel is perforated with chronic enteric fistula formation. Currently, there is no established preventative method for this condition. Hyperdry (HD) amniotic membrane (AM) can promote early granulation tissue formation on the exposed viscera and is suitable for dressing intractable wounds as it possesses anti-inflammatory, antibacterial, and immunomodulatory properties. This study investigated whether HD-AM promotes early formation of blood vessel-containing granulation tissue for enteroatmospheric fistula treatment. METHODS: An experimental animal model of an open wound with exposed bowel was developed. A 15 × 20 mm wound was prepared on the abdomen of Institute of Cancer Research mice, and the HD-AM was placed. The mice were assigned to one of the following groups: HD-AM group, in which the stromal layer of the HD-AM was placed in contact with the exposed bowel; HD-AM UD group, in which the epithelial layer of the HD-AM was placed in contact with the exposed bowel; and the HD-AM (-) or control group, in which the HD-AM was not used. RESULTS: On postoperative days 7 and 14, granulation tissue thickness significantly increased in the HD-AM and HD-AM UD groups compared with that in the HD-AM (-) group. Macrophages accumulated in the HD-AM epithelium only in the HD-AM group. During HD-AM contact, a subset of invading macrophages switched from M1 to M2 phenotype. CONCLUSIONS: HD-AM is a practical wound dressing with its scaffolding function, regulation of TGF ß-1 and C-X-C motif chemokine 5 (CXCL-5), and ability to induce M1-to-M2 macrophage conversion.

Positive effect of acellular amniotic membrane dressing with immobilized growth factors in skin wound healing.

The human amniotic membrane dressing has been shown to accelerate the wound healing process in the clinic. In this study, heparin was conjugated to a human Acellular Amniotic Membrane (hAAM) to provide affinity binding sites for immobilizing growth factors. To study the acceleration of the wound healing process, we bound epidermal growth factor and fibroblast growth factor 1 to heparinized hAAMs (GF-Hep-hAAMs). The heparinized hAAMs (Hep-hAAMs) were characterized by toluidine blue staining and infrared spectroscopy. The quality control of hAAM was performed by hematoxylin staining, swelling capacity test and biomechanical evaluation. The cytotoxicity, adhesion, and migration in vitro assays of GF-Hep-hAAMs on L-929 fibroblast cells were also studied by MTT assay, scanning electron microscopy, and scratch assay, respectively. Finally, in vivo skin wound healing study was performed to investigate the wound closure rate, re-epithelization, collagen deposition, and formation of new blood vessels. The results showed that GF-Hep-hAAMs enhance the rate of wound closure and epidermal regeneration in BALB/c mice. In conclusion, GF-Hep-hAAMs could accelerate the wound healing process, significantly in the first week.

Influence of advanced wound matrices on observed vacuum pressure during simulated negative pressure wound therapy.

Biomaterials and negative pressure wound therapy (NPWT) are treatment modalities regularly used together to accelerate soft-tissue regeneration. This study evaluated the impact of the design and composition of commercially available collagen-based matrices on the observed vacuum pressure delivered under NPWT using a custom test apparatus. Specifically, testing compared the effect of the commercial products; ovine forestomach matrix (OFM), collagen/oxidized regenerated cellulose (collagen/ORC) and a collagen-based dressing (CWD) on the observed vacuum pressure. OFM resulted in an ∼50% reduction in the observed target vacuum pressure at 75 mmHg and 125 mmHg, however, this effect was mitigated to a ∼0% reduction when fenestrations were introduced into the matrix. Both collagen/ORC and CWD reduced the observed vacuum pressure at 125 mmHg (∼15% and ∼50%, respectively), and this was more dramatic when a lower vacuum pressure of 75 mmHg was delivered (∼20% and ∼75%, respectively). The reduced performance of the reconstituted collagen products is thought to result from the gelling properties of these products that may cause occlusion of the delivered vacuum to the wound bed. These findings highlight the importance of in vitro testing to establish the impact of adjunctive therapies on NPWT, where effective delivery of vacuum pressure is paramount to the efficacy of this therapy.

Acellular bovine pericardium as a biological dressing for treatment of cutaneous wounds of the distal limb in donkeys (Equus Asinus).

This research was performed to determine the impact of repeated topical dressing with acellular bovine pericardium (ABP) on healing distal limb wounds in donkeys. Twelve male clinically healthy donkeys were subjected to general anesthesia, and full-thickness wounds of six cm2 (2 × 3 cm) were created on the middle dorsolateral surface of the metacarpi. Two defects were made on each donkey's forelimbs; the right limb was considered a control wound, and the left one was considered a treated wound. Moreover, the control wounds were irrigated with saline every three days postoperatively and bandaged with a standard dressing. The treated wounds were covered with ABP dressings. The ABP dressing was reapplied thrice at 7-, 14- and 21-days post-wound induction. In addition, the wound healing process was monitored clinically, histopathologically, and immunohistochemically of tissue as growth factor-ß1, epidermal growth factor receptor, and vascular endothelial growth factor. Besides, the gene expression profile of angiogenic and myofibroblastic genes was applied as vascular endothelial growth factor-A, collagen type 3α1, fibroblast growth factor 7, and the transforming growth factor-ß1.The results revealed that the wounds treated with ABP healed more quickly than the control wounds. Additionally, the mean days required for healing were significantly shorter in the ABP-treated wounds (p < 0.05; 69.5 ± 1.6) compared to control wounds (86.3 ± 3). Furthermore, immunohistochemical and gene expression analyses were significantly improved in ABP wounds than in control wounds. In conclusion, ABP is considered a natural biomaterial and promotes the healing of distal limb wounds in donkeys if applied weekly during the first three-week post-wound induction.

Effects of irradiated biological dressings on second-degree burn wounds.

Objective: To explore the effect of irradiated biological dressing (IBD) on second degree burn wounds. Methods: Eighty patients with second-degree burns who were treated in our department were selected and randomly divided into IBD group and traditional dressing (TD) group by random number table method. The dressing change, wound healing, comfort and adverse reactions of patients in the two groups were compared and analysed. Results: The number of dressing changes in the IBD group was significantly less than that in the TD group, and the pain degree of dressing changes was significantly lower than that in the TD group (P<0.05). The dressing comfort of the IBD group was higher than that of the TD group, the secondary trauma score was lower than that of the TD group, the wound scar hyperplasia score was lower than that of the TD group, and the healing time was shorter than that of the TD group (P<0.05). There was no statistically significant difference in adverse reactions between the two groups (P>0.05). Conclusion: IBD can promote the healing of second-degree burn wounds, improve patient comfort, reduce secondary trauma and wound scarring, and improve patients' quality of life.

[Collagen-based biological dressings in the treatment of chronic wounds in diabetic foot syndrome]. / Biologicheskie povyazki na osnove kollagena v lechenii khronicheskikh ran pri sindrome diabeticheskoi stopy.

One of the end-organs of diabetes mellitus (DM) is the skin. Cellular and molecular disorders occurring in the skin due to chronic hyperglycemia, neuropathy, and micro- and macroangiopathy lead to poor-heling foot wounds in patients with diabetes. Consequently, treating wounds in diabetic foot syndrome (DFS) is prolonged, costly, and often ineffective. The research on wound healing and treating wounds in DM with stricter adherence to international guidelines and technological breakthroughs in developing biological materials provide new therapeutic opportunities to solve wound care problems. Collagen is one of the body's many proteins, essential throughout the healing phases for skin repair and remodeling. Collagen is one of the body's many proteins, essential throughout the healing phases for skin repair and remodeling. The article addresses the features of biological dressings based on the lyophilized native triple-helix (non-hydrolyzed) collagen formulation. Also, we present clinical cases of their use in different phases of wound healing in DM.

Therapeutic Use of Amniotic Membrane Dressing in Toxic Epidermal Necrolysis.

A 45-year-old woman presented with painful erosions and a few dusky vesiculobullous lesions all over the body, including the face, trunk, arms and legs, and oral and genital mucous membranes, for 3 days after consuming tablet diclofenac for fever. There was hemorrhagic crusting on the lips along with conjunctival hyperemia. A clinical diagnosis of toxic epidermal necrolysis (TEN) was made. The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) was 3 at the time of admission. All routine investigations, including liver function test (LFT), kidney function test (KFT), fasting blood sugar (FBS, 105 mg/dL), and viral serology (Hepatitis B surface antigen [HBsAg], hepatitis C virus [HCV], and Human immunodeficiency virus [HIV]-1, 2), were normal. Blood and urine cultures were sterile. A chest X-ray (posteroanterior [PA] view) and electrocardiogram (ECG) did not reveal any abnormality. The patient was treated conservatively with supportive care, including intravenous fluids, maintenance of ambient temperature, air-fluidized bedding, and appropriate pain and ophthalmic care. For skin lesions, normal saline dressing with paraffin gauge was used; however, after 5 days of treatment, coverage of skin lesions with amniotic membrane dressings was planned due to poor healing. Amniotic membranes are taken from normal delivery patients using aseptic precautions and ensuring negative viral (HBsAg, HCV, and HIV-1, 2) serology. Blood clots were removed from amniotic membranes and stored in buffered normal saline by adding gentamycin. The membranes were applied over the denuded areas (Figures 1 and 2) and wrapped with sterile bandages. The membranes were replaced after 3 days, and removed on day 4 of the second application. More than 90% improvement was observed (Figures 3 and 4) on removal of second application. Supportive treatment was continued, and the patient was discharged on day 20 of admission. (SKINmed. 2022;20:215-217).

The remarkable effect of menstrual blood stem cells seeded on bilayer scaffold composed of amniotic membrane and silk fibroin aiming to promote wound healing in diabetic mice.

INTRODUCTION: Impaired chronic wound healing frequently occurs in diabetic patients. We hypothesized that menstrual blood-derived mesenchymal stem cells (MenSCs) in combination with bilayer scaffold consisted of human amniotic membrane (AM) and electrospun silk fibroin nanofibers could potentially promote wound healing in diabetic mice. METHODS & METHODS: Two bilateral full-thickness wounds were created on dorsal skin of type-1 diabetic mice model and animals were equally divided in four groups including: no-treatment group (NT), amniotic membrane treated group (AM), bilayer scaffold treated group (bSC), and MenSCs-seeded bilayer scaffold treated group (bSC + MenSCs). Wound healing evaluations were performed at 3, 7, and 14 days after their treatment. The wound healing was analyzed by macroscopic and microscopic evaluations, and immunofluorescence staining of involucrin (IVL), type III collagen, CD31/ von Willebrand factor (vWF), and PGP9.5 were performed. Furthermore, number of neutrophils and macrophages and subpopulation of macrophages were assessed. In addition, the expression of Egr2, Mmp9, CXCL12, IDO1, Ptgs2 and VEGFA transcripts involved in wound repair were also analyzed. RESULTS: After 14 days, the best epidermal and dermal regeneration belonged to the cases received bSC + MenSCs as wound dressing. Moreover, the wound healing was typically faster in this group compared to other groups. Immunofluorescence evaluation represented higher levels of CD31 and VWF, higher ratio of M2/M1 macrophages, greater expression of IVL, and higher levels of the PGP9.5 in the bSC + MenSCs group in comparison with other groups. Expression analysis of assessed genes also supported assumption of more regeneration and healing in the bSC + MenSCs group versus other groups. CONCLUSION: These results indicate that enhanced immunomodulatory and reparative properties of MenSCs in conjunction with bilayer scaffold specified this cellular skin substitute for modulating wound chronicity and contribution to resolution of wound healing process in diabetic ulcer.

Fabrication and characterization of biaxially electrospun collagen/alginate nanofibers, improved with Rhodotorula mucilaginosa sp. GUMS16 produced exopolysaccharides for wound healing applications.

Fabrication of scaffolds with enhanced mechanical properties and desirable cellular compatibility is critical for numerous tissue engineering applications. This study was aimed at fabrication and characterization of a nanofiber skin substitute composed of collagen (Col)/sodium alginate (SA)/ polyethylene oxide (PEO)/Rhodotorula mucilaginosa sp. GUMS16 produced exopolysaccharides (EPS) were prepared using the biaxial electrospinning technique. This study used collagen extracted from the bovine tendon as a natural scaffold, sodium alginate as an absorber of excess wound fluids, and GUMS16 produced exopolysaccharides as an antioxidant. Collagen was characterized using FTIR and EDS analyses. The cross-linked nanofibers were characterized by SEM, FTIR, tensile, contact-angle, swelling test, MTT, and cell attachment techniques. The average diameter of Col nanofiber was 910 ± 89 nm. The Col and Col-SA/PEO non-woven mats' water contact angle measurement was 41.6o and 56.4o, Col/EPS1%, Col/EPS2%, Col-SA/PEO + EPS1%, and Col-SA/PEO + EPS2% were 61.4o, 58.3o, 38.5o, and 50.6o, respectively. Cell viability of more than 100% was shown in Col-SA/PEO + EPS nanofibers. Also, SEM images of cells on nanofiber scaffolds demonstrated that all nanofibers incorporated with GUMS16-produced EPS have good cell growth and proliferation. The acquired results expressed that the GUMS16-produced EPS can be considered a novel biomacromolecule in electrospun fibers that increase cell viability and proliferation.

Feasibility study of oxidized hyaluronic acid cross-linking acellular bovine pericardium with potential application for abdominal wall repair.

Bovine pericardium(BP)is one of the biological membranes with extensive application in tissue engineering. To fully investigate the potential clinical applications of this natural biological material, a suitable cross-linking reagent is hopefully adopted for modification. Glutaraldehyde (GA) is a clinically most common synthetic cross-linking reagent. In the study, oxidized hyaluronic acid (AHA) was developed to substitute GA to fix acellular bovine pericardium (ABP) for lower cytotoxicity, aiming to evaluate the feasibility of AHA as a cross-linking reagent and develop AHA-fixed ABP as a biological patch for abdominal wall repair. The AHA with the feeding ratio (1.8:1.0) has an appropriate molecular weight and oxidation degree, almost no cytotoxicity and good cross-linking effect. The critical cross-linking characteristics and cytocompatibility of AHA-fixed ABP were also investigated. The results demonstrated that 2.0% AHA-fixed ABP had the most suitable mechanical properties, thermal stability, resistance to enzymatic degradation and hydrophilicity. Moreover, 2.0% AHA-fixed samples exhibited an excellent cytocompatibility with human peritoneal mesothelial cells (HPMC) and low antigenicity. It also showed a prominent anti-calcification ability required for abdominal wall repair. Our data provided experimental basis for future research on AHA as a new cross-linking reagent and AHA-fixed ABP for abdominal wall repair.

Chitosan/alginate/hyaluronic acid polyelectrolyte composite sponges crosslinked with genipin for wound dressing application.

Wound dressing composed of polyelectrolyte complexes (PECs), based on chitosan/alginate/hyaluronic acid (CS/ALG/HYA) crosslinked by genipin, was prepared by freeze-dried molding. Genipin as excellent natural biological crosslinker was chose for high biocompatibility and improving mechanical properties of materials. The CS/ALG/HYA sponges (CAHSs) were characterized by FTIR, XRD, DSC and SEM. Porosity, swelling behavior and mechanical properties and in vitro degradation of CAHSs were investigated. The cytotoxicity assay was carried out on HUVEC cells in vitro and the result proves the good biocompatibility of CAHSs. Hemolysis tests indicated that the prepared CAHSs were non-hemolytic material (hemolysis ratio < 5%, no cytotoxicity). PT and aPPT coagulation tests demonstrated that CAHS2 and CAHS3 could both activate the extrinsic and intrinsic coagulation pathway and thus accelerated blood coagulation. Further, in a rat full-thickness wounds model, the CAHS2 sponge significantly facilitates wound closure compared to other groups. CAHSs exhibited adjustable physical, mechanical and biological properties. Thus, the chitosan-based polyelectrolyte composite sponges exhibit great potential as promising wound dressings.

Epidermal and fibroblast growth factors incorporated polyvinyl alcohol electrospun nanofibers as biological dressing scaffold.

In this study, single, mix, multilayer Polyvinyl alcohol (PVA) electrospun nanofibers with epidermal growth factor (EGF) and fibroblast growth factor (FGF) were fabricated and characterized as a biological wound dressing scaffolds. The biological activities of the synthesized scaffolds have been verified by in vitro and in vivo studies. The chemical composition finding showed that the identified functional units within the produced nanofibers (O-H and N-H bonds) are attributed to both growth factors (GFs) in the PVA nanofiber membranes. Electrospun nanofibers' morphological features showed long protrusion and smooth morphology without beads and sprayed with an average range of 198-286 nm fiber diameter. The fiber diameters decrement and the improvement in wettability and surface roughness were recorded after GFs incorporated within the PVA Nanofibers, which indicated potential good adoption as biological dressing scaffolds due to the identified mechanical properties (Young's modulus) in between 18 and 20 MPa. The MTT assay indicated that the growth factor release from the PVA nanofibers has stimulated cell proliferation and promoted cell viability. In the cell attachment study, the GFs incorporated PVA nanofibers stimulated cell proliferation and adhered better than the PVA control sample and presented no cytotoxic effect. The in vivo studies showed that compared to the control and single PVA-GFs nanofiber, the mix and multilayer scaffolds gave a much more wound reduction at day 7 with better wound repair at day 14-21, which indicated to enhancing tissue regeneration, thus, could be a projected as a suitable burn wound dressing scaffold.

Systematic review on the rational use of amniotic membrane allografts in diabetic foot ulcer treatment.

BACKGROUND: Diabetic foot ulcer is a complication with multiple aetiological factors which has a significant impact to patients' lives and costs to the healthcare system. The potential of human amniotic membrane to act as an allograft has been studied in relation to this condition. Aim of this study is to evaluate the current scientific evidence on its effectiveness in healing diabetic foot ulcers. METHODS: Pubmed, Cochrane library, and Google scholar were searched using the search terms, "Amnion" OR "Placenta" AND "Diabetic foot". (MeSH terms) in the title or the abstract field from 1st of January 2000 to 30th March 2020. The quality of published reports was assessed using standard methods. We searched for experimental and observational studies in terms of randomized control trials, prospective cohort, retrospective cohort studies and case series. RESULTS: When searched with Mesh terms, 12 citations in PubMed, 22 citations in Cochrane library and 30 in other data bases were found. After screening the studies and their reference lists, 12 studies met the inclusion criteria and the others were excluded. There were 8 randomized control trials (RCTs), 2 prospective studies and 2 retrospective studies employing different preparation methods of the amniotic membranes. A wide variation in study end points were noted. Majority of the RCTs (n = 7) were concluded with significantly higher wound closure rate compared to the conventional treatment groups. In prospective and retrospective studies, it was shown that large chronic ulcers which were resistant to closure with standard therapy achieved wound closure with amniotic membrane allografts. A meta-analysis could not be performed due to study heterogeneity, and publication bias was not assessed due to the small number of available studies which was not sufficient for accurate comparison. CONCLUSION: Even though, the studies had some inherent heterogeneity due to different preparation methods, different study end points and outcome measurements. According to our review the current studies using amniotic membrane allografts give reliable evidence of reduction in healing time over conventional methods.

Associated Neurotrophic Keratopathy in Complex Regional Pain Syndrome.

PURPOSE: To report a case of neurotrophic keratopathy (NK) in a patient with complex regional pain syndrome (CRPS) with ipsilateral facial involvement. METHODS: Case report. RESULTS: An 18-year old woman with a 5-year history of CRPS type I, a systemic disorder with a neuropathic component with associated limb and right facial involvement, presented with an insidious onset of blurred vision and pain in the right eye. Ocular examination revealed decreased corneal sensation, as measured by Cochet-Bonnet testing, associated with recurrent epithelial defects and whorl-like superficial corneal epitheliopathy. NK was suspected and confirmed by in vivo confocal microscopy (IVCM), which revealed rarefaction of the subbasal nerve plexus in the affected eye. To enhance corneal nerve health, plasma rich in growth factors drops were used. Persistence of NK prompted a superficial keratectomy with placement of an amniotic membrane graft and a course of cenegermin 0.002% (Oxervate; Dompé Farmaceutici SpA, Italy) in the postoperative period. This combination therapy resulted in successful epithelial closure and vision improvement after 8 weeks of therapy with no recurrence of disease for 11 months. Importantly, at that final visit, IVCM demonstrated growth of corneal nerves for the first time in this patient. CONCLUSIONS: This is the first case report of NK occurring in the context of CRPS, a neuropathy with ipsilateral facial pain involvement. IVCM was important in the diagnosis of NK, which responded successfully to ocular surface treatments focused on nerve health stimulation that ultimately resulted in corneal nerve growth.

In-vivo evaluation of Alginate-Pectin hydrogel film loaded with Simvastatin for diabetic wound healing in Streptozotocin-induced diabetic rats.

Previously we developed and characterized a novel hydrogel film wound dressing containing Sodium Alginate and Pectin loaded with Simvastatin with multi-functional properties. This study investigated the in-vivo efficacy of the developed wound dressing on type I diabetic wound model. Experiments were performed on male Wistar rats for the period of 21-days. Animals developed diabetes after intraperitoneal injection (50 mg/kg) of Streptozotocin then randomly divided into different groups. On days 7, 14, and 21 of post-wounding, animals were euthanized and the wounds tissue were harvested for analysis. The wound healing rate, hematology and histological analysis, hydroxyproline assay, and Vascular Endothelial Growth Factor A measurements were noted. The results revealed that the wound dressing healed the wounded area significantly (p < 0.05) higher than the control after 21-day treatment and wound closure was ~99% without any adverse systemic reactions. Histological analysis qualitatively revealed an enhanced re-epithelialization and collagen deposition. Moreover, results also showed an improved rate of collagen synthesis and angiogenesis in the group treated with the hydrogel film loaded with Simvastatin. Thus, the present study demonstrated that developed film holds great potential for the acceleration of diabetic wound healing by its pro-angiogenic effect, faster re-epithelialization and increased collagen deposition.

Amniotic membrane dressing versus nitrofurazone-impregnated dressing in the treatment of second-degree burn wounds: a randomized clinical trial.

INTRODUCTION: Both the amniotic membrane biologic dressing and nitrofurazone-impregnated dressing are treatment options for burn wounds. OBJECTIVE: To compare the efficacy of these treatments in healing second-degree burns, a randomized clinical trial was conducted among patients with second-degree burns who had no comorbidities or history of addiction and were referred to a burn center in Urmia, Iran, between December 2017 and September 2019. MATERIALS AND METHODS: Patients were randomly assigned to one of 2 study groups. Wounds were dressed in either amniotic membrane covered with moistened gauze/petrolatum or nitrofurazone-impregnated gauze. Comparative groups were matched according to percentage of burn (total body surface area). The dressing application occurred once daily in the nitrofurazone group and once weekly in the amniotic membrane group. The study was conducted until all wounds healed. The study outcomes included the infection rate of the wound, pain severity related to dressing changes, dressing change frequency, epithelialization rate, hospitalization length of stay, morphine use, and scarring. Data were collected in real time by the researcher via observation, interview, examination of the patient, and, eventually, completion of a checklist. Analyzed quantitative and qualitative variables were reported as mean ± standard deviation and percentage (frequency). RESULTS: Each group included 35 participants (24 men, 11 women; age, 20.05 ± 3.60 years in the amniotic dressing group; and 20 men, 15 women; age, 21.60 ± 2.02 years in the nitrofurazone-impregnated gauze group). Assessment was performed on days 1, 7, 14, and 30 from the initial treatment and at discharge. No significant difference was noted in the rate of infection between the 2 groups. Epithelialization was complete (100%) by day 7 in the amniotic membrane group, versus 77% in the nitrofurazone group. Pain following dressing application, length of hospitalization, morphine use, and scarring at day 14 were significantly lower (P < .05) in the amniotic membrane group. CONCLUSIONS: This study indicated that the use of amniotic membrane dressing improved factors key to healing in second-degree burn wounds compared with nitrofurazone-impregnated dressing. Further research with a larger sample is warranted.