Amnion Wound Covering for Enhanced Wound Healing
Primary Purpose
Burns, Wound of Skin, Skin Wound
Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Amnion Membrane Powder
SOC Wound Covering
Sponsored by
About this trial
This is an interventional treatment trial for Burns focused on measuring Human amnion membrane, Autologous skin graft, Scar Formation
Eligibility Criteria
Inclusion Criteria:
- The subject requires autologous primary skin graft with two donor sites in similar areas, each measuring at least 25 cm2 with the likely depth of 0.012 inches and separated by a 5 cm gap. It is preferable that the two sites be on right and left sides of the body, but it is not an exclusion if they must be on the same side.
- Eligible primary wound sites may be traumatic or chronic, and will be at least 50 cm2 (that will receive the donor graft) to allow assessment of two separate experimental donor sites of 25 cm2.
- The subject is between the ages of 18 and 85 years of age.
- The subject is willing to complete all follow-up evaluations required by the study protocol.
- The subject is to abstain from any other covering or treatment of the wound(s) for the duration of the study unless medically necessary.
- The subject agrees to abstain from enrollment in any other interventional clinical trial for the duration of the study.
- The subject and/or guardian is able to read and understand instructions and give informed, voluntary, written consent.
- The subject is able and willing to follow the protocol requirements
Exclusion Criteria:
- The subject's primary wound site is less than 50 cm2The subject's primary wound site is not deemed appropriate for skin graft based upon the investigator's clinical experience
- The subject has a microbiologically proven pre-existing local or systemic bacterial infection.
- The subject has been receiving a systemic antibiotic for more than 48 hours prior to grafting.
- Unstable cardiac disorders within the past 6 months including angina, abnormal ECG, history of cardiac arrest, surgery and/or other interventional procedure.
- Hepatic disease or altered liver function as defined by ALT or AST value >3 times the upper limit of normal and/or T. Bilirubin >1.5 mg/dL at screening
- Renal disease or altered renal function as defined by serum creatinine > 2 mg/dL at screening, or end-stage renal disease.
- Hemoglobin <10.0 or >19.0 g/dL
- Known coagulopathy or platelet disorder, or INR > 1.6 , PTT > 38 sec; PLT < 50,000 at screening
- The subject is known to have a pre-existing, chronic condition that, in the opinion of the Investigator, may interfere with wound healing including but not limited to: current malignancy, uncontrolled diabetes (HbA1c >8) or diabetic ulcers, autoimmune disease or other immunocompromised diseases, renal impairment or ESRD, liver disease, hematological
Sites / Locations
- Wake Forest University Health SciencesRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Amnion membrane product treatment area
SOC Wound Covering treatment area
Arm Description
The prepared amnion membrane powder will be directly applied to the prepared donor wound site (Site A). The wound will then be covered with the SOC dressing.
The donor wound site (Site B) will be covered per SOC (Standard of care).
Outcomes
Primary Outcome Measures
Incidence of Donor Site Wound Closure
Wound closure for both amnion membrane product and SOC will be defined as skin re-epithelization without drainage or dressing requirements confirmed at two consecutive study visits 2 weeks apart.
Secondary Outcome Measures
Incidence of Donor Site Wound Healing
Wound Healing for both amnion membrane product and SOC will be assessed clinically confirmed at two consecutive study visits 2 weeks apart.
Presence of infection
The presence of infection will be evaluated in accordance with guidelines derived from Cutting and Harding using standard clinical measures.
Vancouver Scar Assessment Scale
Scar formation will be evaluated the Vancouver Scar Assessment Scale.The scale is composed by the following Sub scales (minimum and maximum ranges in parenthesis): Pigmentation (0-2), Vascularity (0-3), Pliability (0-5), Height (0-3). Total score 0-13. Lower score denotes better outcomes for total range and subscales.
Presence of Dermatitis
Allergic Response to Human Amnion Membrane Product Covering will be assessed clinically by the presence of dermatitis.
Full Information
NCT ID
NCT03754218
First Posted
November 21, 2018
Last Updated
May 1, 2023
Sponsor
Wake Forest University Health Sciences
1. Study Identification
Unique Protocol Identification Number
NCT03754218
Brief Title
Amnion Wound Covering for Enhanced Wound Healing
Official Title
Phase 1 Study of Human Amnion Membrane Powder for Enhanced Wound Healing
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 1, 2019 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wake Forest University Health Sciences
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this research study is to find our if human amnion membrane powder can be safely used as a covering for wounds and can improve the condition of skin graft donor sites. The amnion powder product is composed of "lyophilized" (freeze-dried), "gamma irradiation sterilized" (exposed to bacteria killing radiation) fragments of amniotic membrane.
Detailed Description
Extensive burns and full thickness skin wounds can be devastating to patients, even when treated with our current standard of care. There are an estimated 500,000 burns treated in the United States each year. Moreover, in the military environment, soldiers who suffer from extensive burn injuries on the battlefield may benefit from rapid treatments that result in complete closure and protection of the wounds. As such, there is a need for mobile platform technologies that allow fast treatment at the site where the injury occurred, or at the very least at the forward operating sites. This safety investigation of a human amnion membrane powder product for wound healing is a with-in patient-controlled study, enrolling 10 subjects undergoing donor skin graft harvest. The single-center study will include patients undergoing donor skin harvest such that two regions, of at least 25 cm2 and separated by at least a 5 cm gap, of donor site wounds in comparable skin locations, are available for covering with the amnion membrane product and the current institutional standard of care (SOC) covering. The proposed sterilized product is composed of lyophilized, gamma-irradiated powder made from amniotic membrane for topical application with the purpose of enhanced wound healing.
The primary objective of the study is to evaluate the safety of a human amnion membrane product intended for enhanced wound healing. The secondary objective is efficacy as evidenced by complete wound closure relative to standard of care (SOC) treatment in a similar wound on the same subject at donor sites created for skin grafts at 14 days and 28 days postoperatively.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Burns, Wound of Skin, Skin Wound
Keywords
Human amnion membrane, Autologous skin graft, Scar Formation
7. Study Design
Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
10 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Amnion membrane product treatment area
Arm Type
Experimental
Arm Description
The prepared amnion membrane powder will be directly applied to the prepared donor wound site (Site A). The wound will then be covered with the SOC dressing.
Arm Title
SOC Wound Covering treatment area
Arm Type
Active Comparator
Arm Description
The donor wound site (Site B) will be covered per SOC (Standard of care).
Intervention Type
Drug
Intervention Name(s)
Amnion Membrane Powder
Intervention Description
This sterilized product is composed of lyophilized, gamma-irradiated powder made from amniotic membrane for topical application with the purpose of enhanced wound healing.
Intervention Type
Procedure
Intervention Name(s)
SOC Wound Covering
Intervention Description
Institutional standard of care wound covering.
Primary Outcome Measure Information:
Title
Incidence of Donor Site Wound Closure
Description
Wound closure for both amnion membrane product and SOC will be defined as skin re-epithelization without drainage or dressing requirements confirmed at two consecutive study visits 2 weeks apart.
Time Frame
Week 4
Secondary Outcome Measure Information:
Title
Incidence of Donor Site Wound Healing
Description
Wound Healing for both amnion membrane product and SOC will be assessed clinically confirmed at two consecutive study visits 2 weeks apart.
Time Frame
week 12
Title
Presence of infection
Description
The presence of infection will be evaluated in accordance with guidelines derived from Cutting and Harding using standard clinical measures.
Time Frame
up to 26 Weeks
Title
Vancouver Scar Assessment Scale
Description
Scar formation will be evaluated the Vancouver Scar Assessment Scale.The scale is composed by the following Sub scales (minimum and maximum ranges in parenthesis): Pigmentation (0-2), Vascularity (0-3), Pliability (0-5), Height (0-3). Total score 0-13. Lower score denotes better outcomes for total range and subscales.
Time Frame
up to 26 Weeks
Title
Presence of Dermatitis
Description
Allergic Response to Human Amnion Membrane Product Covering will be assessed clinically by the presence of dermatitis.
Time Frame
Up to 26 Weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
The subject requires autologous primary skin graft with two donor sites in similar areas, each measuring at least 25 cm2 with the likely depth of 0.012 inches and separated by a 5 cm gap. It is preferable that the two sites be on right and left sides of the body, but it is not an exclusion if they must be on the same side.
Eligible primary wound sites may be traumatic or chronic, and will be at least 50 cm2 (that will receive the donor graft) to allow assessment of two separate experimental donor sites of 25 cm2.
The subject is between the ages of 18 and 85 years of age.
The subject is willing to complete all follow-up evaluations required by the study protocol.
The subject is to abstain from any other covering or treatment of the wound(s) for the duration of the study unless medically necessary.
The subject agrees to abstain from enrollment in any other interventional clinical trial for the duration of the study.
The subject and/or guardian is able to read and understand instructions and give informed, voluntary, written consent.
The subject is able and willing to follow the protocol requirements
Exclusion Criteria:
The subject's primary wound site is less than 50 cm2The subject's primary wound site is not deemed appropriate for skin graft based upon the investigator's clinical experience
The subject has a microbiologically proven pre-existing local or systemic bacterial infection.
The subject has been receiving a systemic antibiotic for more than 48 hours prior to grafting.
Unstable cardiac disorders within the past 6 months including angina, abnormal ECG, history of cardiac arrest, surgery and/or other interventional procedure.
Hepatic disease or altered liver function as defined by ALT or AST value >3 times the upper limit of normal and/or T. Bilirubin >1.5 mg/dL at screening
Renal disease or altered renal function as defined by serum creatinine > 2 mg/dL at screening, or end-stage renal disease.
Hemoglobin <10.0 or >19.0 g/dL
Known coagulopathy or platelet disorder, or INR > 1.6 , PTT > 38 sec; PLT < 50,000 at screening
The subject is known to have a pre-existing, chronic condition that, in the opinion of the Investigator, may interfere with wound healing including but not limited to: current malignancy, uncontrolled diabetes (HbA1c >8) or diabetic ulcers, autoimmune disease or other immunocompromised diseases, renal impairment or ESRD, liver disease, hematological
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Joseph Molnar, MD, PhD
Phone
13367164153
Email
JMolnar@wakehealth.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Mary Clare Day, RN
Phone
336-713-1343
Email
mday@wakehealth.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joseph Molnar, MD, PhD
Organizational Affiliation
Wake Forest University Health Sciences
Official's Role
Principal Investigator
Facility Information:
Facility Name
Wake Forest University Health Sciences
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Individual Site Status
Recruiting
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
21929986
Citation
Lesher AP, Curry RH, Evans J, Smith VA, Fitzgerald MT, Cina RA, Streck CJ, Hebra AV. Effectiveness of Biobrane for treatment of partial-thickness burns in children. J Pediatr Surg. 2011 Sep;46(9):1759-63. doi: 10.1016/j.jpedsurg.2011.03.070.
Results Reference
background
PubMed Identifier
21852044
Citation
Rahmanian-Schwarz A, Beiderwieden A, Willkomm LM, Amr A, Schaller HE, Lotter O. A clinical evaluation of Biobrane((R)) and Suprathel((R)) in acute burns and reconstructive surgery. Burns. 2011 Dec;37(8):1343-8. doi: 10.1016/j.burns.2011.07.010. Epub 2011 Aug 17.
Results Reference
background
PubMed Identifier
13735672
Citation
PIGEON J. Treatment of second-degree burns with amniotic membranes. Can Med Assoc J. 1960 Oct 15;83(16):844-5. No abstract available.
Results Reference
background
PubMed Identifier
6155575
Citation
Faulk WP, Matthews R, Stevens PJ, Bennett JP, Burgos H, Hsi BL. Human amnion as an adjunct in wound healing. Lancet. 1980 May 31;1(8179):1156-8. doi: 10.1016/s0140-6736(80)91617-7.
Results Reference
background
PubMed Identifier
496235
Citation
Bose B. Burn wound dressing with human amniotic membrane. Ann R Coll Surg Engl. 1979 Nov;61(6):444-7.
Results Reference
background
PubMed Identifier
23902526
Citation
Koob TJ, Rennert R, Zabek N, Massee M, Lim JJ, Temenoff JS, Li WW, Gurtner G. Biological properties of dehydrated human amnion/chorion composite graft: implications for chronic wound healing. Int Wound J. 2013 Oct;10(5):493-500. doi: 10.1111/iwj.12140. Epub 2013 Aug 1.
Results Reference
background
PubMed Identifier
2590408
Citation
Sawhney CP. Amniotic membrane as a biological dressing in the management of burns. Burns. 1989 Oct;15(5):339-42. doi: 10.1016/0305-4179(89)90015-6.
Results Reference
background
Citation
C. Ho, K. Tran, M. Hux, G. Sibbald, K. Campbell, Artificial skin grafts in chronic wound care: A meta-analysis of clinical efficacy and a review of cost-effectiveness, (2005).
Results Reference
background
Citation
Thapliyal, G.K., Kumar, V. and Gour, S., Amniotic Membrane: An Innovative Material for Repair and Regeneration in Oral and Maxillofacial region-A Review. Rama University Journal & Dental Sciences, 3(2) (2016) 1-6.
Results Reference
background
Citation
J.S. Davis, Skin transplantation, Johns Hopkins Hospital Reports 15 (1910) 307-96
Results Reference
background
PubMed Identifier
19474753
Citation
Pachigolla G, Prasher P, Di Pascuale MA, McCulley JP, McHenry JG, Mootha VV. Evaluation of the role of ProKera in the management of ocular surface and orbital disorders. Eye Contact Lens. 2009 Jul;35(4):172-5. doi: 10.1097/ICL.0b013e3181a66a12.
Results Reference
background
PubMed Identifier
10811093
Citation
Honavar SG, Bansal AK, Sangwan VS, Rao GN. Amniotic membrane transplantation for ocular surface reconstruction in Stevens-Johnson syndrome. Ophthalmology. 2000 May;107(5):975-9. doi: 10.1016/s0161-6420(00)00026-9.
Results Reference
background
PubMed Identifier
22951345
Citation
Mohammadi AA, Seyed Jafari SM, Kiasat M, Tavakkolian AR, Imani MT, Ayaz M, Tolide-ie HR. Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods. Burns. 2013 Mar;39(2):349-53. doi: 10.1016/j.burns.2012.07.010. Epub 2012 Aug 27.
Results Reference
background
PubMed Identifier
17920202
Citation
Branski LK, Herndon DN, Celis MM, Norbury WB, Masters OE, Jeschke MG. Amnion in the treatment of pediatric partial-thickness facial burns. Burns. 2008 May;34(3):393-9. doi: 10.1016/j.burns.2007.06.007. Epub 2007 Oct 24.
Results Reference
background
PubMed Identifier
12781617
Citation
Ravishanker R, Bath AS, Roy R. "Amnion Bank"--the use of long term glycerol preserved amniotic membranes in the management of superficial and superficial partial thickness burns. Burns. 2003 Jun;29(4):369-74. doi: 10.1016/s0305-4179(02)00304-2.
Results Reference
background
PubMed Identifier
21353745
Citation
Hermans MH. Preservation methods of allografts and their (lack of) influence on clinical results in partial thickness burns. Burns. 2011 Aug;37(5):873-81. doi: 10.1016/j.burns.2011.01.007. Epub 2011 Feb 25.
Results Reference
background
PubMed Identifier
24560801
Citation
Fairbairn NG, Randolph MA, Redmond RW. The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg. 2014 May;67(5):662-75. doi: 10.1016/j.bjps.2014.01.031. Epub 2014 Jan 31.
Results Reference
background
PubMed Identifier
24088931
Citation
Lo K, Kohanim S, Trief D, Chodosh J. Role of amniotic membrane transplantation in acute chemical injury. Int Ophthalmol Clin. 2013 Fall;53(4):33-41. doi: 10.1097/IIO.0b013e31829ceec8. No abstract available.
Results Reference
background
PubMed Identifier
9402822
Citation
Tseng SC, Prabhasawat P, Lee SH. Amniotic membrane transplantation for conjunctival surface reconstruction. Am J Ophthalmol. 1997 Dec;124(6):765-74. doi: 10.1016/s0002-9394(14)71693-9.
Results Reference
background
PubMed Identifier
12666850
Citation
Ganatra MA. Amniotic membrane in surgery. J Pak Med Assoc. 2003 Jan;53(1):29-32. No abstract available.
Results Reference
background
PubMed Identifier
17645603
Citation
Koziak A, Salagierski M, Marcheluk A, Szczesniewski R, Sosnowski M. Early experience in reconstruction of long ureteral strictures with allogenic amniotic membrane. Int J Urol. 2007 Jul;14(7):607-10. doi: 10.1111/j.1442-2042.2007.01781.x.
Results Reference
background
PubMed Identifier
19404691
Citation
Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J. 2009 Aug;18(8):1202-12. doi: 10.1007/s00586-009-1013-x. Epub 2009 Apr 30.
Results Reference
background
PubMed Identifier
11789753
Citation
Chou CT, Lee C, Hwang JL. Amniotic membrane used for vulvar adhesion treatment. Arch Gynecol Obstet. 2001 Nov;265(4):223-4. doi: 10.1007/s004040000164.
Results Reference
background
PubMed Identifier
25876055
Citation
Fetterolf DE, Snyder RJ. Scientific and clinical support for the use of dehydrated amniotic membrane in wound management. Wounds. 2012 Oct;24(10):299-307.
Results Reference
background
PubMed Identifier
23742102
Citation
Zelen CM, Serena TE, Denoziere G, Fetterolf DE. A prospective randomised comparative parallel study of amniotic membrane wound graft in the management of diabetic foot ulcers. Int Wound J. 2013 Oct;10(5):502-7. doi: 10.1111/iwj.12097. Epub 2013 Jun 7.
Results Reference
background
PubMed Identifier
24159656
Citation
Zelen CM. An evaluation of dehydrated human amniotic membrane allografts in patients with DFUs. J Wound Care. 2013 Jul;22(7):347-8, 350-1. doi: 10.12968/jowc.2013.22.7.347.
Results Reference
background
Citation
C.M. Zelen, T.E. Serena, D.E. Fetterolf, Dehydrated human amnion/chorion membrane allografts in patients with chronic diabetic foot ulcers: a long-term follow-up study, Wound Medicine 4 (2014) 1-4
Results Reference
background
PubMed Identifier
22886294
Citation
Forbes J, Fetterolf DE. Dehydrated amniotic membrane allografts for the treatment of chronic wounds: a case series. J Wound Care. 2012 Jun;21(6):290, 292, 294-6. doi: 10.12968/jowc.2012.21.6.290.
Results Reference
background
PubMed Identifier
23409746
Citation
Sheikh ES, Sheikh ES, Fetterolf DE. Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds. Int Wound J. 2014 Dec;11(6):711-7. doi: 10.1111/iwj.12035. Epub 2013 Feb 15.
Results Reference
background
PubMed Identifier
20236771
Citation
Bujang-Safawi E, Halim AS, Khoo TL, Dorai AA. Dried irradiated human amniotic membrane as a biological dressing for facial burns--a 7-year case series. Burns. 2010 Sep;36(6):876-82. doi: 10.1016/j.burns.2009.07.001. Epub 2010 Mar 16.
Results Reference
background
PubMed Identifier
25653880
Citation
Subach BR, Copay AG. The use of a dehydrated amnion/chorion membrane allograft in patients who subsequently undergo reexploration after posterior lumbar instrumentation. Adv Orthop. 2015;2015:501202. doi: 10.1155/2015/501202. Epub 2015 Jan 13.
Results Reference
background
PubMed Identifier
19660039
Citation
Kurd SK, Hoffstad OJ, Bilker WB, Margolis DJ. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound Repair Regen. 2009 May-Jun;17(3):318-25. doi: 10.1111/j.1524-475X.2009.00487.x.
Results Reference
background
PubMed Identifier
19903300
Citation
Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, Gottrup F, Gurtner GC, Longaker MT. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009 Nov-Dec;17(6):763-71. doi: 10.1111/j.1524-475X.2009.00543.x.
Results Reference
background
PubMed Identifier
18972720
Citation
Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 summary. Natl Health Stat Report. 2008 Aug 6;(3):1-39.
Results Reference
background
PubMed Identifier
18958996
Citation
Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report. 2008 Aug 6;(7):1-38.
Results Reference
background
PubMed Identifier
18997556
Citation
Miller SF, Bessey P, Lentz CW, Jeng JC, Schurr M, Browning S; ABA NBR Committee. National burn repository 2007 report: a synopsis of the 2007 call for data. J Burn Care Res. 2008 Nov-Dec;29(6):862-70; discussion 871. doi: 10.1097/BCR.0b013e31818cb046. No abstract available.
Results Reference
background
PubMed Identifier
27922298
Citation
Cutting KF, Harding KG. Criteria for identifying wound infection. J Wound Care. 1994 Jun 2;3(4):198-201. doi: 10.12968/jowc.1994.3.4.198.
Results Reference
background
PubMed Identifier
8537427
Citation
Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995 Sep-Oct;16(5):535-8. doi: 10.1097/00004630-199509000-00013.
Results Reference
background
PubMed Identifier
19212431
Citation
Molnar JA, Lew WK, Rapp DA, Gordon ES, Voignier D, Rushing S, Willner W. Use of standardized, quantitative digital photography in a multicenter Web-based study. Eplasty. 2009;9:e4. Epub 2009 Jan 12.
Results Reference
background
PubMed Identifier
21681125
Citation
Dornseifer U, Lonic D, Gerstung TI, Herter F, Fichter AM, Holm C, Schuster T, Ninkovic M. The ideal split-thickness skin graft donor-site dressing: a clinical comparative trial of a modified polyurethane dressing and aquacel. Plast Reconstr Surg. 2011 Oct;128(4):918-924. doi: 10.1097/PRS.0b013e3182268c02.
Results Reference
background
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Amnion Wound Covering for Enhanced Wound Healing
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