A case series of the use of amniotic membrane (AM) for treating chronic nonhealing wounds. It presents five cases of polymorbid patients with a total of nine chronic nonhealing wounds. The patient group consisted of four men and one woman with various comorbidities, aged 45-72 years. The mean initial wound size was 15.8 cm2, and the mean time from the onset of the wound to the first application of AM was 122 weeks. The wounds were caused by chronic venous insufficiency and/or peripheral arterial disease. Wounds were treated in a standardized protocol. AM was applied weekly in the first month and then every two weeks. Photo documentation of the wound and microbiological colonization was carried out at each visit. In three out of five patients, the AM treatment effectively promoted healing up to complete wound closure. In two cases, the wounds stayed unhealed despite numerous AM applications. Pain relief was noted in all patients. The success of the treatment was closely tied to patient factors, such as adherence to the prescribed treatment regimen and individual patient characteristics. In some cases, treatment failure was observed, possibly due to underlying comorbidities, wound parameters, or poor patient compliance. AM treatment has the potential to become a viable treatment option for these nonhealing wounds. However, the effectiveness of the treatment may be influenced by various patient factors and the underlying cause of the wound. Therefore, it is crucial to have an individualized treatment plan that considers these particular factors.

2nd Department of Surgery Department of Cardiovascular Surgery 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Obstetrics and Gynaecology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Transplantation and Tissue Bank Motol University Hospital Prague Czech Republic

Department of Vascular Surgery Na Homolce Hospital Prague Czech Republic

Laboratory of Biology and Pathology of the Eye Institute of Biology and Medical Genetics 1st Faculty of Medicine and General Teaching Hospital Charles University Albertov 4 128 01 Prague Czech Republic

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Ahmajarvi KM, Isoherranen KM, Makela A, Venermo M. A change in the prevalence and the etiological factors of chronic wounds in Helsinki metropolitan area during 2008–2016. Int Wound J. 2019;16:522–526. doi: 10.1111/iwj.13077. PubMed DOI PMC

Al-Gharibi KA, Sharstha S, Al-Faras MA. Cost-effectiveness of wound care: a concept analysis. Sultan Qaboos Univ Med J. 2018;18:e433–e439. doi: 10.18295/squmj.2018.18.04.002. PubMed DOI PMC

Dadkhah Tehrani F, Firouzeh A, Shabani I, Shabani A. A review on modifications of amniotic membrane for biomedical applications. Front Bioeng Biotechnol. 2020;8:606982. doi: 10.3389/fbioe.2020.606982. PubMed DOI PMC

Eriksson E, Liu PY, Schultz GS, Martins-Green MM, Tanaka R, Weir D, et al. Chronic wounds: treatment consensus. Wound Repair Regen. 2022;30:156–171. doi: 10.1111/wrr.12994. PubMed DOI PMC

Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care (new Rochelle) 2015;4:560–582. doi: 10.1089/wound.2015.0635. PubMed DOI PMC

Gibbons GW. Grafix®, a cryopreserved placental membrane, for the treatment of chronic/stalled wounds. Adv Wound Care (new Rochelle) 2015;4:534–544. doi: 10.1089/wound.2015.0647. PubMed DOI PMC

Jarbrink K, Ni G, Sonnergren H, Schmidtchen A, Pang C, Bajpai R, et al. Prevalence and incidence of chronic wounds and related complications: a protocol for a systematic review. Syst Rev. 2016;5:152. doi: 10.1186/s13643-016-0329-y. PubMed DOI PMC

Jirsova K, Jones GLA. Amniotic membrane in ophthalmology: properties, preparation, storage and indications for grafting-a review. Cell Tissue Bank. 2017;18:193–204. doi: 10.1007/s10561-017-9618-5. PubMed DOI

King AE, Paltoo A, Kelly RW, Sallenave JM, Bocking AD, Challis JR. Expression of natural antimicrobials by human placenta and fetal membranes. Placenta. 2007;28:161–169. doi: 10.1016/j.placenta.2006.01.006. PubMed DOI

Krupová L, Pokorná A. Quality of life in patients with non-healing wounds, with particular focus on assesment tools—a literature review. Cent Eur J Nurs Midwifery. 2020;11:94–103. doi: 10.15452/cejnm.2020.11.0010. DOI

Lavery LA, Fulmer J, Shebetka KA, Regulski M, Vayser D, Fried D, et al. The efficacy and safety of Grafix((R)) for the treatment of chronic diabetic foot ulcers: results of a multi-centre, controlled, randomised, blinded, clinical trial. Int Wound J. 2014;11:554–560. doi: 10.1111/iwj.12329. PubMed DOI PMC

Mao Y, Jacob V, Singal A, Lei S, Park MS, Lima MRN, et al. Exosomes secreted from amniotic membrane contribute to its anti-fibrotic activity. Int J Mol Sci. 2021 doi: 10.3390/ijms22042055. PubMed DOI PMC

Martin P, Nunan R. Cellular and molecular mechanisms of repair in acute and chronic wound healing. Br J Dermatol. 2015;173:370–378. doi: 10.1111/bjd.13954. PubMed DOI PMC

Navas A, Magana-Guerrero FS, Dominguez-Lopez A, Chavez-Garcia C, Partido G, Graue-Hernandez EO, et al. Anti-inflammatory and anti-fibrotic effects of human amniotic membrane mesenchymal stem cells and their potential in corneal repair. Stem Cells Transl Med. 2018;7:906–917. doi: 10.1002/sctm.18-0042. PubMed DOI PMC

Nussbaum SR, Carter MJ, Fife CE, DaVanzo J, Haught R, Nusgart M, et al. An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value Health. 2018;21:27–32. doi: 10.1016/j.jval.2017.07.007. PubMed DOI

Odet S, Louvrier A, Meyer C, Nicolas FJ, Hofman N, Chatelain B, et al. Surgical application of human amniotic membrane and amnion-chorion membrane in the oral cavity and efficacy evaluation: corollary with ophthalmological and wound healing experiences. Front Bioeng Biotechnol. 2021;9:685128. doi: 10.3389/fbioe.2021.685128. PubMed DOI PMC

Odet S, Meyer C, Gaudet C, Weber E, Quenot J, Derruau S, et al. Tips and tricks and clinical outcome of cryopreserved human amniotic membrane application for the management of medication-related osteonecrosis of the jaw (MRONJ): a pilot study. Front Bioeng Biotechnol. 2022;10:936074. doi: 10.3389/fbioe.2022.936074. PubMed DOI PMC

Olsson M, Jarbrink K, Divakar U, Bajpai R, Upton Z, Schmidtchen A, et al. The humanistic and economic burden of chronic wounds: a systematic review. Wound Repair Regen. 2019;27:114–125. doi: 10.1111/wrr.12683. PubMed DOI

Pesteil F, Oujaou-Faiz K, Drouet M, Roussane MC, Aboyans V, Cornu E, et al. Cryopreserved amniotic membranes use in resistant vascular ulcers. J Mal Vasc. 2007;32:201–209. doi: 10.1016/j.jmv.2007.07.003. PubMed DOI

Raffetto JD, Ligi D, Maniscalco R, Khalil RA, Mannello F. Why venous leg ulcers have difficulty healing: overview on pathophysiology, clinical consequences, and treatment. J Clin Med. 2021 doi: 10.3390/jcm10010029. PubMed DOI PMC

Serena TE, Yaakov R, DiMarco D, Le L, Taffe E, Donaldson M, et al. Dehydrated human amnion/chorion membrane treatment of venous leg ulcers: correlation between 4-week and 24-week outcomes. J Wound Care. 2015;24:530–534. doi: 10.12968/jowc.2015.24.11.530. PubMed DOI

Svobodova A, Horvath V, Smeringaiova I, Cabral JV, Zemlickova M, Fiala R, et al. The healing dynamics of non-healing wounds using cryo-preserved amniotic membrane. Int Wound J. 2022;19:1243–1252. doi: 10.1111/iwj.13719. PubMed DOI PMC

Svobodova A, Vrkoslav V, Smeringaiova I, Jirsova K. Distribution of an analgesic palmitoylethanolamide and other N-acylethanolamines in human placental membranes. PLoS ONE. 2023;18:e0279863. doi: 10.1371/journal.pone.0279863. PubMed DOI PMC

Svobodova A, Horvath V, Balogh L, Zemlickova M, Fiala R, Burkert J, et al. Outcome of application of cryopreserved amniotic membrane grafts in the treatment of chronic nonhealing wounds of different origins in polymorbid patients: a prospective multicenter study. Bioengineering (Basel) 2023;29:900. doi: 10.3390/bioengineering10080900. PubMed DOI PMC

Tapking C, Boson AL, Rontoyanni VG, Hundeshagen G, Kowalewski KF, Popp D, et al. A systematic review and meta-analysis of 30-day readmission rates following burns. Burns. 2020;46:1013–1020. doi: 10.1016/j.burns.2019.11.001. PubMed DOI

Zelen CM, Gould L, Serena TE, Carter MJ, Keller J, Li WW. A prospective, randomised, controlled, multi-centre comparative effectiveness study of healing using dehydrated human amnion/chorion membrane allograft, bioengineered skin substitute or standard of care for treatment of chronic lower extremity diabetic ulcers. Int Wound J. 2015;12:724–732. doi: 10.1111/iwj.12395. PubMed DOI PMC