The aim of this study was to evaluate the clinical outcome of the surgical repair of oral mucosal defects using cryopreserved human amniotic membrane (HAM) as a graft material. Thirty-four patients with precancerous lesions such as leukoplakia, erythroplakia, and verrucous hyperplasia were included. Fresh amniotic membrane was obtained from women undergoing elective caesarean section; the membrane was cleaned, prepared in antibiotic solutions, and preserved at −80 °C. Results suggested that HAM promotes healing and epithelialization without specific complications. Thus we conclude that the use of HAM gives promising results in the repair of post-surgical oral mucosal defects.
The amniotic membrane is a tissue of foetal origin. It is the innermost layer of the foetal membranes and comprises a single layer of epithelial cells on a thicker basement membrane and a spongy collagen layer containing mesenchymal cells. The amniotic membrane has been considered a suitable tissue for allograft based on its low immunogenicity. It also possesses anti-inflammatory, anti-fibrotic, and anti-angiogenic properties and also accelerates wound healing and epithelialization. It has been used for nearly a century in reconstructive surgery. The use of foetal membrane in skin transplantation was first reported by Davis in 1910. In 1913, Stern and Sabella described the use of human amniotic membrane (HAM) on burned and ulcerated skin surfaces.
In oral surgery, Lawson first used amniotic membrane with a pectoralis major muscle flap for intraoral lining in 1985. Lai et al. used a single layer of fresh amnion for the surgical treatment of oral submucous fibrosis in 1995. The use of amnion in vestibuloplasty has been reported by Guler et al. (1997) and Samandari et al. (2004). In 2009, Gurinsky described the use of amnion allograft in the treatment of gingival recession. In 2010, Kesting and Denys evaluated the use of multilayer HAM as a grafting material for the repair of mid-palate oronasal fistulas in seven Berlin minipigs. More recently, Tuncel and Ozgenel studied the efficacy of HAM as an interpositional material in the prevention of temporomandibular joint (TMJ) reankylosis in a randomized rabbit model. Many other studies, such as those by Sikder et al. , Arai et al. , and Tsuno et al. , have also shown encouraging results in the correction of oral mucosal defects.
The present study investigated the effectiveness of HAM as a suitable graft material in the repair of post-surgical mucosal defects in the oral cavity.
Materials and methods
This prospective study included 34 patients (26 males and eight females) ranging in age from 21 to 60 years. Written consent was provided by the patients included in this study (both donors and recipients), and the approval of the institutional ethics committee was obtained prior to study commencement. The patients were found to be in good general health, presenting with categorized oral mucosal defects, as defined by clinical and histopathological examination. The exclusion criteria for the patients considered for this study were the following: any involvement of systemic medical disease, an immune compromised state, history of allergy to drugs and medications used in the study, atopic individual, current pregnancy or breast feeding/lactating mother, localized infections in the region of grafting, and patients not willing to attend regular follow-up.
Preparation of the human amniotic membrane graft
The amniotic membrane was procured from the placenta of healthy pregnant women undergoing elective caesarean sections in the department of obstetrics and gynaecology. All necessary precautions were taken to exclude immunocompromised conditions and various transmissible diseases, including human immunodeficiency virus (HIV), hepatitis B and C viruses, and sexually transmitted diseases like syphilis. The amniotic membrane graft was prepared and preserved as described by Kim and Tseng and in consultation with the department of biochemistry in their sophisticated laboratory, as described below ( Fig. 1 ).