Copyright © 2019 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. The Use of Dehydrated Human Amniotic Membrane Versus Amniotic/Chorionic Membrane Allografts to Treat Partial Thickness Facial Burns Salomon Puyana, MD, MS,  Samuel Ruiz, MD,  Adel Elkbuli, MD, MPH,  Eileen Bernal, MD,  Mark McKenney, MD, MBA, z Morad Askari, MD, MBA, y Rizal Lim, MD,  and Haaris Mir, MD y Background: Facial burns have significant physical and psycho- logic effects on patients. Human dehydrated amniotic membrane represents novel technology, yet its outcome has not been suffi- ciently studied to guide practice. The objective of our study is to compare the benefits of amniotic membrane (DHAM) to amniotic/ chorionic membrane (DHACM) skin substitutes to treat partial thickness facial burns. Methods: Retrospective review of data collected from our institutional burn registry from 2012 to 2016. Demographic characteristics including age, total body surface area (TBSA) burn and injury severity scores were collected and outcome measures were compared between the 2 groups. Paired sample t-test and Chi-squared were used with significance defined as P < 0.05. Results: A total of 77 adult patients with partial thickness facial burns who received DHAM and DHACM skin substitutes were included in the analysis. The mean age for the DHAM group was 39.8 compared to 41.4 for the DHACM. Mean TBSA was similar, with 10.9% in the DHAM group compared to 8.3% in the DHACM. Patients receiving DHAM had higher requirement for skin substitute surgical reapplications as compared to the DHACM group (23.7% versus 5.1%, P  0.05). Remaining morbidities remained low and not significantly different between patients receiving DHAM and DHACM substitutes (P > 0.05). Conclusion: The DHAM and DHACM skin substitutes are valid and safe alternatives in the treatment of adult partial thickness facial burns. Key Words: Amniotic membrane, facial burns, patient safety, quality outcomes (J Craniofac Surg 2019;00: 00–00) F acial burns are devastating injuries that can have lasting physical and psychologic effects in patients. 1 The optimal management of facial burns to decrease morbidity continues to challenge recon- structive surgeons. 2 Complications such as hypertrophic scar for- mation are often underestimated as a significant source of morbidity. 3 Scarring is especially problematic with large burn wounds in cosmetic and sensitive areas such as the face, neck, hands, feet, and other joints as they result in significant physical, functional, and psychologic disabilities. 4 In the face, postburn contractures can lead to deformities of the nose, eyes, and mouth, which frequently require multiple revision procedures. 4 Tissue engineering aims at minimizing and preventing morbid- ities associated with facial burns by producing skin substitutes that offer the advantages of regenerating innate skin. Currently available skin substitutes allow for partial restoration of skin function. 5 Among these, the use of homologous skin biologic wound dressings pose many advantages to restore skin function yet they have not been readily available for off-the-shelf use. Davis 1st reported the clinical applications of amniotic membrane skin substitute in 1910. 6,7 Kucan et al in 1982 reported a limited series of patients were amniotic membrane was successfully used as dressings for facial dermabrasion wounds. 8 Its clinical use remained limited until recently a new manufacturing process that dehydrates and cleanses human amniotic membrane skin while maintaining its native growth factors and regulatory molecules creating a readily available skin substitute for mass production (Epifix, AmnioFix, Epiburn; MiMedx Group Inc, Marietta, GA). 9,10 Dehydrated human amniotic/chorionic membrane (DHACM) contains intact but nonviable cells and is known to have cytokines and chemokines that aid in wound healing. 9,11,12 The amniotic membrane provides a novel nonimmunogenic, antiinflammatory, and antibacterial skin substitute that provides a matrix for cellular migration and proliferation as it has more than 220 growth factor cytokines and chemokines, many of which are involved in the regulation of wound healing and inflammation. 13 The highest concentrations of growth factors tend to derive from the chorionic layer with a notable exception of epidermal growth factor. 6,14 DHACM has been shown in vitro studies to recruit fibroblasts and promote endothelial cell proliferation. 14 Furthermore, it is proposed that the recruitments of progenitor endothelial cells modulate inflammation and upregulates the healing process. 14 The use of amniotic and chorionic membrane skin substitutes in facial burn injury has not been sufficiently studied to guide prac- tices. Limited number of research studies show it is effective in improving burn wound healing and outcomes in other parts of the From the  Department of Surgery, Kendall Regional Medical Center; y Burn & Reconstructive Centers of Florida, Miami; and z Department of Surgery, University of South Florida, Tampa, FL. Received January 29, 2019. Accepted for publication May 30, 2019. Address correspondence and reprint requests to Salomon Puyana, MD, MS, 11750 SW 40th Ave, Miami, FL 33175; E-mail: Salomon.puyanabarcha@hcahealthcare.com This research was supported by Kendall Regional Medical Center, an HCA affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA or any of its affiliated entities. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jcraniofa- cialsurgery.com). Copyright # 2019 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000005834 CLINICAL STUDY The Journal of Craniofacial Surgery  Volume 00, Number 00, Month 2019 1