Amniotic membrane in surgery.

The first reported use of fetal membrane as skin substitute was by Davis in 1910. 1 In 1913, Salbella presented the first clinical report of successful use of amniotic membrane in the treatment of burns and skin ulcerations. 2 In 1940, DeRoth reported the use of amniotic membrane in the repair of conjuctival defects. From 1940 to 1965 a number of clinical trials of successful use of amniotic membrane for use in acute skin injuries appear in the literature. 3-7 However no practical methods of preparation, sterilization and storage were suggested and this fact seems to have limited the use of this modality prior to 1965. In 1965 Dino et al 8 demonstrated that amniotic membrane from routine deliveries could be sterilized and kept for six weeks at 4°C and safely used on acute second degree burns and on skin donor sites. This encouraging report stimulated great interest amongst clinicians and has resulted in numerous reports in the world literature documenting thousands of patients with successful healing of all kinds of skin lesions. Amnion is a thin, tough, transparent membrane. It is about 10-15 micrometer thick. It is made up of two membranes, the inner amniotic membrane and the outer chorion. Chorionic side of the membrane is rougher and mucinous. Amnion can easily be separated from chorion leave and placenta as far as the umbilical cord. Once separated, the amnion is found to be smooth and shining and much tougher and more elastic and easier to clean than the thicker chorion, which does not strip from the placenta. 1 1 The chorion, although thicker, is more easily torn because it is much less elastic. It is not entirely clear whether the amniotic membrane is primarily nourished by the amniotic fluid or diffusion from the chorion, but the presence of significant AlP and glycogen in the amniotic fluid suggests that the latter is the main source of nourishment of the amniotic membrane. 9