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O iginal Resea ch A icle
A Re iew om Clinical Pe spec i es o Amnio ic Memb ane D essing Vs
O he D essing Me hods on Bu n Ulce s o Child en in Te ia y
Heal hca e Se ups
Mollina h Mukhe jee1, Ind anil Roy2, Raj Gup a3, P iyoda shi Sengup a4, Ni anjan
Bha acha ya5
1MBBS, DGO, MRCOG, MRCP (Dublin), FRCS , DM, Mphil, Resea ch Schola , Depa men o
Regene a i e Medicine and T ansla ional Science, School o T opical Medicine, Kolka a, Wes Bengal
700073
2M. Sc., M. Phil, Resea ch Schola , Depa men o Regene a i e Medicine and T ansla ional Science,
School o T opical Medicine, Kolka a, Wes Bengal 700073
3M. Sc., M. Phil, Resea ch Schola , Depa men o Regene a i e Medicine and T ansla ional Science,
School o T opical Medicine, Kolka a, Wes Bengal 700073
4M.Sc., M. Phil, Resea ch Schola , Depa men o Regene a i e Medicine and T ansla ional Science,
School o T opical Medicine, Kolka a, Wes Bengal 700073
5MBBS, MD, MS, D.Sc., FACS, FICS, Fo me P o esso , Depa men o Regene a i e Medicine and
T ansla ional Science, School o T opical Medicine, Kolka a, Wes Bengal 700073
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 27-08-2025
Co esponding Au ho : Ind anil Roy
Con lic o in e es : Nil
Abs ac
Bu n inju ies in child en ep esen a signi ican clinical challenge due o hei unique ana omical and
physiological cha ac e is ics, including hinne skin, highe isk o luid imbalance, and g ea e suscep ibili y o
in ec ion and sca ing. E ec i e wound managemen is c ucial o p omo e apid healing, minimize pain, p e en
complica ions, and imp o e long- e m unc ional and aes he ic ou comes. Among he a ious d essing me hods,
amnio ic memb ane (AM) has eme ged as a p omising biological d essing due o i s ich ex acellula ma ix,
g ow h ac o s, an i-in lamma o y p ope ies, and immunological sa e y. This e iew c i ically examines he
clinical pe spec i es o AM d essing in compa ison o con en ional and ad anced wound d essings, including
sil e sul adiazine, hyd ocolloids, and pa a in gauze, in paedia ic bu n ca e wi hin e ia y heal hca e se ups.
Key ou comes, including epi helializa ion a e, in ec ion con ol, pain educ ion, equency o d essing changes,
hospi al s ay, and sca o ma ion, a e analyzed o e alua e he e ec i eness and p ac icali y o AM in paedia ic
popula ions. The e iew also add esses challenges ela ed o AM p epa a ion, s o age, and applica ion,
highligh ing gaps in cu en esea ch and oppo uni ies o u u e s udies. The e idence sugges s ha AM
d essing o e s signi ican ad an ages in paedia ic bu n managemen , pa icula ly in enhancing healing
ou comes and pa ien com o , and may ep esen a aluable adjunc o al e na i e o con en ional d essing
me hods in e ia y ca e se ings.
Keywo ds: Amnio ic Memb ane; Paedia ic Bu ns; Biological D essing; Analgesia; In ec ion;
Re-Epi helializa ion; Cos -E ec i eness..
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
Bu n inju ies in child en emain a signi ican global
heal h bu den, accoun ing o conside able
mo bidi y, mo ali y, and long- e m disabili y
despi e ad ances in acu e ca e and econs uc i e
su ge y. The Wo ld Heal h O ganiza ion (WHO)
es ima es ha bu ns a e one o he leading causes
o inju y- ela ed dea hs in child en unde he age o
en, pa icula ly in low- and middle-income
coun ies whe e heal hca e esou ces a e o en
limi ed [1]. Pedia ic bu ns a e dis inc om adul
bu ns due o hinne skin, imma u e immunological
esponses, and highe isks o luid imbalance,
in ec ion, and hype ophic sca ing [2].
Managemen o bu n ulce s in child en is he e o e
pa icula ly challenging and equi es in e en ions
ha no only p omo e apid wound healing bu also
minimize pain, p e en in ec ion, and educe he
isk o long- e m unc ional and aes he ic sequelae
[3]. The choice o wound d essing plays a c i ical
ole in he ou come o pedia ic bu n managemen .
T adi ional d essings, such as sil e sul adiazine,
pa a in gauze, and hyd ocolloids, ha e been
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159
widely used o decades. While hese d essings can
p o ide mois u e, abso b exuda e, and educe
mic obial coloniza ion, hey o en necessi a e
equen changes, which a e pain ul and auma ic
o child en, and may delay epi helializa ion [4].
Fu he mo e, he cy o oxic e ec s o sil e -based
d essings and hei po en ial o impai ke a inocy e
p oli e a ion ha e aised conce ns ega ding hei
ou ine use in child en [5]. Consequen ly, esea ch
has inc easingly ocused on iden i ying biologically
ac i e d essings ha can accele a e healing while
o e ing supe io biocompa ibili y and pa ien
com o .
Among he newe biological d essings, amnio ic
memb ane (AM) has gained conside able a en ion
in pedia ic bu n ca e. The amnio ic memb ane,
de i ed om he inne mos laye o he placen a, is
ich in ex acellula ma ix p o eins, g ow h ac o s,
and an i-in lamma o y cy okines, making i a
na u ally biocompa ible and immunologically ine
ma e ial [6].
I s unique composi ion allows i o se e as a
empo a y biological d essing ha no only
p o ides a physical ba ie agains mic obial
in asion bu also acili a es epi helial cell
mig a ion, angiogenesis, and pain educ ion [7].
AM has been success ully used in oph halmology,
ch onic ulce s, and su gical wound managemen ,
and i s ex ension in o pedia ic bu n ca e ep esen s
a p omising ansla ional applica ion [8]. Compa ed
wi h con en ional d essings, AM o e s se e al
heo e ical and p ac ical ad an ages. I adhe es
easily o he wound su ace, educes e apo a i e
wa e loss, and main ains a mois wound
en i onmen , which is c i ical o op imal healing.
Impo an ly, AM educes pain by co e ing exposed
ne e endings, he eby minimizing he need o
equen analgesics in child en. S udies ha e also
sugges ed ha AM d essing lowe s he equency
o d essing changes, he eby educing hospi al s ay,
inancial cos s, and psychological dis ess o bo h
he child and hei ca egi e s [9]. Addi ionally, i s
an i- ib o ic p ope ies may play a ole in
minimizing hype ophic sca o ma ion, a majo
conce n in pedia ic bu n su i o s. Howe e ,
despi e hese ad an ages, challenges emain in
s anda dizing he p epa a ion, p ese a ion, and
applica ion o AM, which may in luence i s
e icacy. Issues ela ed o dono sc eening,
s e iliza ion, and s o age me hods—such as
c yop ese a ion, lyophiliza ion, o glyce ol
p ese a ion—can a ec i s biological ac i i y and
clinical ou comes. Mo eo e , accessibili y and
cos -e ec i eness o AM d essings compa ed wi h
con en ional ma e ials may a y depending on
egional heal hca e in as uc u e [10].
Aims and Objec i es
Aim: The p ima y aim o his e iew is o e alua e
he clinical e ec i eness, sa e y, and p ac ical
u ili y o amnio ic memb ane (AM) d essing
compa ed o con en ional and ad anced d essing
me hods in he managemen o bu n ulce s in
pedia ic pa ien s wi hin e ia y heal hca e se ings.
Objec i es
1. To sys ema ically analyze exis ing li e a u e on
he use o amnio ic memb ane as a biological
d essing o pa ial- and ull- hickness bu n
ulce s in child en.
2. To compa e he healing ou comes o AM
d essing wi h o he con en ional d essings,
including hyd ocolloids, sil e sul adiazine,
pa a in gauze, and o he ad anced wound ca e
ma e ials.
3. To assess he impac o AM d essing on
pedia ic-speci ic ac o s such as pain
educ ion, equency o d essing changes,
hospi al s ay, and psychological com o .
4. To e alua e he po en ial o AM d essing in
minimizing complica ions, including in ec ion,
delayed epi helializa ion, and hype ophic sca
o ma ion.
5. To iden i y challenges, limi a ions, and
p ac ical conside a ions in he p epa a ion,
s o age, and applica ion o amnio ic memb ane
in e ia y heal hca e se ups.
6. To highligh knowledge gaps in cu en
pedia ic bu n ca e esea ch and sugges
di ec ions o u u e clinical s udies.
Ma e ials & Me hods
This e iew was conduc ed o sys ema ically
analyze and compa e he clinical e ec i eness o
amnio ic memb ane (AM) d essings e sus o he
con en ional and ad anced d essing me hods in he
managemen o bu n ulce s among pedia ic
pa ien s in e ia y heal hca e se ups.
S udy Design: A comp ehensi e li e a u e sea ch
was pe o med ollowing a na a i e e iew
me hodology, ocusing on s udies published
be ween 2000 and 2025. Bo h p ospec i e and
e ospec i e s udies, andomized con olled ials
(RCTs), obse a ional s udies, and case se ies
add essing bu n wound managemen in child en
we e conside ed.
Da a Sou ces: Elec onic da abases including
PubMed, Scopus, Web o Science, and Google
Schola we e sea ched using a combina ion o
keywo ds and Medical Subjec Headings (MeSH)
e ms such as “amnio ic memb ane d essing,”
“bu n ulce ,” “pedia ic bu ns,” “wound healing,”
“ e ia y ca e,” and “compa a i e d essing.”
Addi ional s udies we e iden i ied h ough
e e ence lis s o ele an a icles.
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160
Inclusion C i e ia
• S udies in ol ing pa ien s o age ≤18 yea s
wi h bu n ulce s.
• S udies compa ing AM d essings wi h o he
d essing me hods, including sil e
sul adiazine, hyd ocolloid, hyd o ibe , and
con en ional gauze d essings.
• S udies epo ing clinical ou comes such as
ime o wound healing, in ec ion a es, pain
sco es, need o g a ing, and hospi al s ay.
Exclusion C i e ia
• S udies in ol ing adul pa ien s o mixed
popula ions wi hou sepa a e pedia ic da a.
• Re iews, edi o ials, le e s o edi o s, and non-
English publica ions.
• S udies wi h incomple e da a on clinical
ou comes.
Resul and Obse a ion
B anski LK e al 11 (2008) showed ha wound
co e age o second-deg ee bu ns emains a
clinical challenge. They p esen ed a no el and
s anda dized p ocu emen and p ocessing me hod
o amnion and in es iga e, whe he he use o his
biological d essing is sa e and may ep esen a new
he apeu ic op ion o child en wi h pa ial-
hickness acial bu ns compa ed o s anda d opical
ea men . Pa ien s wi h pa ial- hickness bu ns o
he ace, neck and head admi ed be ween 2003 and
2005 we e included in ha s udy. They we e
di ided in o wo g oups o ecei e ei he amnion (n
= 53) o opical an imic obials (n = 49).
Demog aphics (age, gende , e hnici y, TBSA, bu n
a eas), leng h o hospi al s ay (LOS), a e o
in ec ions (RI), ime o o al healing, and equency
o d essing changes we e compa ed be ween he
wo g oups. The long- e m ou come was assessed
in nine pa ien s in he amnion g oup and eigh
pa ien s in he opical g oup, who e u ned o up o
12-mon h ollow-up isi s. Pa ien s in he amnion
g oup had signi ican ly less d essing changes hen
in he con ol g oup (p < 0.05). Time o healing,
leng h o s ay and he de elopmen o hype ophic
sca ing was no di e en be ween he g oups. Use
o amnion was no associa ed wi h an inc eased isk
o local in ec ion. This s udy indica es ha amnion
is sa e and has ad an ages as wound co e age o
second-deg ee acial bu ns compa ed o he
s anda d opical oin men s.
Bujang-Sa awi E e al 12 (2010) ound ha acial
bu ns a e common and ha e a signi ican impac on
pa ien unc ion and psychosocial wellbeing.
Human amnion has been used o many yea s as a
empo a y biological wound d essing in he
managemen o pa ial hickness bu ns. Thei s udy
e alua ed hei 7 yea s o wo king wi h d ied
i adia ed human amnion in he ea men o acial
bu ns. The e ec i eness o he ea men was
de e mined by wound in ec ion a e, equency o
d essing eapplica ion, healing ime and esul ing
sca ing. Thi y- h ee pa ien s wi h supe icial
pa ial hickness bu n we e iden i ied (25 males, 8
emales). The a e age age o he pa ien s was 16.5
yea s ( ange: 8 mon hs o 64 yea s). The causes
included scalding (n = 15), con ac bu ning (n = 13)
and lash bu ning (n = 5). The mean pe cen o al
acial su ace a ea bu ned was 2.7% ( ange: 0.5–
8.5%). None o he pa ien s de eloped acial
wound in ec ions. Eigh y- i e pe cen (n = 28) o
he pa ien s needed a single applica ion o he d ied
amnion. The a e age healing ime was 5.4 days
( ange: 2–14 days). Thi een pa ien s (39%) had
bu ns con ined o he acial a ea, o which h ee
we e discha ged and ea ed as ou pa ien s. Long-
e m ollow up showed wo hypopigmen ed sca s,
one hype pigmen ed sca and one hype ophic
sca . Supe icial pa ial hickness acial bu ns can
be e ec i ely ea ed wi h d ied i adia ed human
amnion memb ane.
Ramak ishnan KM e al 13 (2013) obse ed ha
collagen based d essings o acu e bu n wound
managemen ha e been ex ensi ely used in India,
pa icula ly in he ci y o Chennai. Due o he high
le els o humidi y in ou ci y, closed d essings
become in ec ed and ea men wi h opical
an imic obials, like Sil e Sul adiazine c eam,
quickly become desicca ed. Collagen memb ane
d essings we e manu ac u ed by he bioma e ial
labo a o y o he Cen al Lea he Resea ch Ins i u e
(CLRI), Go e nmen o India in Chennai, and hen
he p ocess was pa en ed. Collagen was ex ac ed
om bo ine skin and Achilles endons, and hen
econs i u ed. This was used on bu n wounds as
d essings a e clea ance om he Ins i u ional
Re iew Boa d and E hics Commi ees o he
Hospi al and CLRI. Con inued esea ch in his ield
o enable esul ed in he design o sil e
sulphadiazine loaded algina e mic osphe es which
we e embedded in he econs i u ed collagen.
Con olled deli e y o sil e sulphadiazine. This
collagen memb ane was used in ch onic in ec ed
bu ns. Low molecula weigh hepa in was gi en
subcu aneously o imp o e wound healing in bu n
inju ies and collagen memb ane d essings we e
also applied. A e se e al ials he p ocess
echnology was pa en ed. The ad an ages and
disad an ages o he collagen memb ane co e was
elabo a ed in a g oup o 487 pedia ic bu n pa ien s.
The ial was conduc ed a he bu n uni o
KanchiKamako i Childs T us Hospi al (KKCTH)
in Chennai, India. Vloemans AF e al 15 (2014)
showed ha a la ge pa o he pa ien popula ion o
a bu n cen e consis s o child en, mos o whom
a e younge han ou yea s. The majo i y o hese
young child en su e om supe icial and deep
pa ial hickness scald bu ns ha may easily deepen
o ull hickness bu ns. They pe o med a
sys ema ic e iew o wound managemen and
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161
d essing ma e ials o selec he bes ea men
op ion o child en wi h bu ns. A sea ch in Medline
and Embase e ealed 51 a icles o a c i ical
app aisal. The a icles we e di ided in o
andomized con olled ials, coho s udies and a
g oup o case- epo s. To al app aisal did no di e
much amongs he g oups; he le el o e idence
was highes in he andomized con olled ials and
lowes in he case- epo s. In 16 ou o 34
compa a i e s udies, sil e sul adiazine o a sil e
sul adiazine/chlo hexidine-glucona e combina ion
was he s anda d o wound ca e ea men . The
compe i o d essing was Biob ane® in six s udies
and amnion memb ane in h ee. Tulle gauze, o
ulle gauze imp egna ed wi h an an ibac e ial
addi ion we e he s anda d o ca e ea men in
se en s udies. In gene al, memb anous d essings
like Biob ane® and amnion memb ane pe o med
be e han he s anda d o ca e on epi helializa ion
a e, leng h o hospi al s ay and pain o ea men
o pa ial hickness bu ns in child en. Howe e ,
ha dly any o he s udies in es iga ed long- e m
esul s like sca o ma ion.
Ullah MS e al 16 (2015) ound ha he aim o his
s udy was o ind ou he e ec i eness o amnio ic
memb ane g a d essing in he ea men o
supe icial pa ial hickness bu n in child en. The
e ospec i e s udy was conduc ed on he pa ien s
admi ed wi h supe icial pa ial hickness bu n in
he bu n uni o Dhaka Shishu Hospi al age 0-12
yea s, du ing he pe iod om Janua y 1999 o
Decembe 2011. All o hem ea ed wi h amnion
memb ane g a d essing. To al 370 pa ien s we e
included in his s udy. Mean age was 2.76 yea s.
Amnion d essing supp esses bac e ia in he wound
as well as educed in ec ion. Amnions ha e good
adhe en cha ac e is ics, which educed in ec ion as
well as educ ion o oozing o plasma om he
wound, ha become d y ea ly. I has a ole on bu n
pain educ ion, equency o d essing change, a e
o healing, cos , du a ion o hospi al s ay. Thei
expe ience showed ha amnio ic memb ane is one
o he e ec i e biological skin subs i u es used in
bu n wounds, wi h e icacy o low bac e ial coun s,
has ad an ageous o educing p o ein loss,
elec oly es & luids. Dec easing he isk o
in ec ion minimizing pain, accele a e o wound
healing and good handling p ope ies. I is cos
e ec i e and e y help ul o de eloping coun ies.
Azzena B e al 18 (2018) explo e ha Lyell
Synd ome (TEN, Toxic epide mal nec olysis)
ep esen s a medical eme gency pa icula ly in
pedia ic pa ien s in whom he massi e skin
damage can quickly lead o mul i-o gan
dys unc ion and dea h. They epo ed he use o
amnio ic memb anes in a pedia ic case o se e e
Lyell Synd ome wi h comple e skin su ace, ocula
and mucosal in ol emen wi h li e h ea ing
p esen a ion. A 7-yea old emale was admi ed o
Bu n Cen e o se e e cu aneous/mucosal
ex olia ion (100% To al body su ace a ea, TBSA)
as a esul o an ad e se eac ion o ibup o en
adminis a ion. Suppo i e luid adminis a ion,
ca diac-pulmona y assis ance and pain
managemen we e complemen ed by se ial g a ing
o amnio ic memb anes on all a ec ed a eas o
p o ide co e age o he ex olia ed skin/mucosa.
Biopsies we e ob ained o moni o his ological skin
changes. The pa ien showed an excellen esponse
o amnio ic memb ane ea men , wi h apid
es o a ion o mucosal and cu aneous laye s in he
g a ed a eas. This esul ed in a dec eased need o
d essing changes, a oidance o addi ional su ge ies
and a educed dependence on suppo i e he apy.
Lowe pain le els han usually expec ed led o a
educed need o na co ic pain medica ions and
allowed o ea ly physical ehabili a ion and a sho
hospi al s ay. His ology con i med e idence o
opical immune-modula ion in ea ed a eas
( educ ion o in lamma o y in il a e).
Puyana S e al 19 (2022) showed ha acial bu ns
ha e las ing physical and psychological e ec s on
pedia ic pa ien s. P ope managemen o minimize
mo bidi ies challenges econs uc i e su geons.
New echnologies allowed he de elopmen o skin
subs i u es such as amnio ic and cho ionic
memb anes, ye he use o hese skin d essings and
hei impac on bu n ou comes ha e no been
su icien ly s udied o guide p ac ices. The
objec i e o hei s udy was o epo on he
ou comes o dehyd a ed amnio ic memb ane as a
biologic skin d essing in pedia ic acial bu n inju y
compa ed o cada e ic allog a s. The s udy
popula ion included pa ien s younge han 16 yea s
wi h acial bu ns. Pa ien s be ween 2012 and 2014
ecei ed cada e ic allog a s, whe eas du ing 2015
o 2016 pa ien s ecei ed dehyd a ed human
amnio ic/cho ionic memb ane as s anda d
ea men . Demog aphic cha ac e is ics and
ou come measu es we e compa ed be ween he 2
g oups. Included 30 pa ien s wi h a mean age o 3.7
yea s and wi h an a e age o al body su ace a ea
bu n o 6.8% (2%–27%). Mean inju y se e i y
sco es did no signi ican ly di e be ween bo h
g oups, 1.8 in amnio ic g oup e sus 2.3 in
cada e ic skin g oup (P > 0.05). The e we e 4
complica ions (3 hype ophic sca s and 1 wound
in ec ion) in he cada e ic allog a s g oup e sus
no complica ions in he amnio ic memb ane g oup
(P < 0.05). They concluded ha dehyd a ed
amnio ic/cho ionic memb ane wound d essings a e
a sa e al e na i e o cada e ic allog a s in ea ing
pedia ic pa ial hickness acial bu ns.
Fi os Khan A e al 20 (2020) compa ed be ween
e ec i eness o placen al d essings o e
con en ional d essings in pa ien s wi h i s and
second deg ee bu ns. In hei s udy 70 cases we e
s udied wi h 10-30%TBSA i s and second deg ee
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162
bu ns alloca ed o 2 g oups. 36 pa ien s ecei ed
amnio ic memb ane d essing p epa ed om human
placen a (AM g oup) and 34 pa ien s ecei ed
con en ional d essing wi h sil e sulphadiazine and
cu icell (CD g oup) and assessed o compliance o
pa ien on iew o pain, numbe o d essing
changes and ime equi ed o epi helializa ion and
hospi al s ay. In hei s udy mean age in he
Amnio ic memb ane d essing (AM) g oup is 18.9
yea s whe eas in he Con en ional d essing (CD)
g oup is 30.9 yea s. Among he 36 pa ien s in AM
G oup had 21 male (58.3%) and 15 emale (47.1%)
whe eas among 34 pa ien s in CD g oup had 16
males (47.1%) and 18 (52.9%) emales and a mean
pe cen age o TBSA i s and second deg ee bu ns
o 18.8% in AM and 21.1% espec i ely. Wi h a
mean Pain sco e on day 1 pos admission o 8.8 in
AM g oup and 8.7 in CD, Pain sco e on Day 3 in
he AM g oup was 3.5 and CD g oup is 7.6 wi h a
signi ican p alue. In AM g oup and CD g oup,
A e age o al numbe o d essings used was 1.4
and 15.1, Mean ime o epi helialisa ion is 14.5
days and 21.6 days, Mean hospi al s ay o 13.2
days and 19.7 days espec i ely wi h p alue
<0.001 which is highly signi ican . CONCLUSION
Wi h his i can be concluded ha Amnio ic
memb ane d essings in i s and second deg ee
bu ns a e supe io o con en ional
sil e sulphadiazine d essing in e ms o less pain ,
p ac ically a single applica ion d essing , as e
epi helialisa ion and he eby as e wound healing
and a educed hospi al s ay.
Yang C A e al 22 (2021) aimed o e alua e he ole
o AM d essings in bu n wounds. A sys ema ic
sea ch o he PubMed, Coch ane, Embase, and
Web o Science da abases was conduc ed in Ma ch
2020. The sea ch was conduc ed o iden i y
andomized con ol ials ha compa ed selec ed
ea u es o AM wi h hose o o he d essings, such
as sil e sul adiazine, polyu e hane memb ane, and
honey. Fo skin-g a ed wounds, hey compa ed
AM-co e ed skin g a s and adi ional s aple- ixed
skin g a s. Ou comes o in e es o he e icacy
analysis included wound in ec ion, pain, i ching,
sca ing, and healing ime. The numbe o ad e se
e en s in each ea men g oup, he a e o
wi hd awal because o ad e se e ec s, he cos o
ea men , and pa ien accep abili y we e assessed
o he easibili y analysis. Ele en andomized
con olled ials wi h 816 pa icipan s o al we e
iden i ied in ou e iew. Amnio ic memb ane
ea men was mo e e ec i e han con en ional
me hods, sil e sul adiazine, and polyu e hane
memb ane in ea ing bu n wounds, bu AM
appea s o be less e ec i e han honey. No epo s
o AM- ela ed disease ansmission o ad e se
eac ions we e desc ibed in he included a icles.
Amnio ic memb ane has bene icial e ec s in
ea ing bu n wounds; howe e , he e idence as pe
hei e sion needed o be s eng hened by u he
obus andomized con olled ials.
Chak abo y SK e al 23 (2022) showed ha
adia ion s e ilized human amnio ic memb ane
allog a s a e used as biological d essing o wounds
in ehabili a i e su ge y. The amnio ic memb ane is
used in many di e en clinical si ua ions such as:
hea bu n, chemical bu ns, diabe ic wound/ diabe ic
oo ulce , lep o ic ulce , abdominal wall
econs uc ion, p e igium emo al si e, pe iphe al
co neal ulce , in he managemen o p essu e so e,
e c.Non- iable lyophilized/o en-d ied adia ion
s e ilized amnio ic memb ane allog a s could be
p ocessed o u iliza ion as empo a y biological
d essing o wounds. The allog a s used clinically
should no be he ca ie s o ge ms o a sou ce o
in ec ion. Human cho io-amnio ic memb anes
collec ed o p ocessing as issue allog a s o be
used as biological d essings we e epo ed o be
con amina ed wi h mic oo ganisms such as species
o S aphylococcus, Mic ococcus, Bacillus and
Pseudomonas.Howe e , o en d ied (40ºC) o
eeze d ied (-50ºC) human amnio ic memb anes
we e ound o be s e ilized by i adia ion wi h he
dose o 25 kiloG ay (kGy) o gamma
adia ion.Ca e ul sc eening and selec ion o issue
dono s, p ope p ocessing and gamma adia ion
s e iliza ion o human amnio ic memb anes
minimize he isk o disease ansmission o
ecipien s h ough allog a s. Lő incz A e al 24
(2022) ound ha Paedia ic second-deg ee bu n
inju ies a e a signi ican sou ce o medical
challenges o he popula ion ha may cause se e e,
li elong complica ions. Cu en ly, he e a e dozens
o he apeu ic modali ies and we aimed o
summa ise hei epo ed ou comes and de e mine
hei e ec i eness, compa ed o he widely used
sil e sulphadiazine (SSD). Me hods: We
conduc ed he me a-analysis and sys ema ic e iew
o andomised con olled ials (RCTs), which
in es iga ed he pe o mance o d essings in acu e
paedia ic pa ial- hickness bu ns. The e alua ed
endpoin s we e ime un il wound closu e, g a ing
and in ec ion a e, numbe o d essing changes and
leng h o hospi alisa ion. Resul s: Twen y-nine
RCTs we e included in he quali a i e and 25 in he
quan i a i e syn hesis, bu only h ee ials
compa ed SSD di ec ly o he same in e en ion
(Biob ane). Da a analysis showed a endency o
as e healing imes and a educed complica ion
a e linked o biosyn he ic, sil e oam and amnion
memb ane d essings. A subs an ial di e ence was
ound be ween he numbe o d essing changes
associa ed wi h less pain, na cosis and ea men
du a ion. Conclusions: Conside able be ween-s udy
he e ogenei y was caused by he unequal dep h
subca ego y a io and su ace a ea o he inju ies;
he e o e, no signi ican di e ence was ound in he
main ou comes. Fu he esea ch is necessa y o
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Mukhe jee e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
163
es ablish he mos e ec i e ea men o hese
bu ns.
Singh S e al 25 (2023) obse ed ha he es ic ed
dono a ea in paedia ic pa ien s demands he use o
Human Amnio ic memb ane (hAM) in he
managemen o di icul - o-manage wounds. I can
be used di ec ly o e wounds o used o g ow s em
cells by di e en cul u e me hods. The hAM can be
used “ esh” i.e., +4O glyce ol p ese ed o
“c yop ese ed”. In his li e a u e e iew, we
sea ched ‘PubMed’, ‘Web o Science’ and
’SCOPUS’ o expe imen al models, RCT,
Obse a ional s udies, case se ies, and case epo s
in ol ing he usage o hAM in he ea men o
neona al and paedia ic (<14 y s.) pa ien s,
published in om 1993 o Ap il 2022. The sea ch
included he keywo ds, “amnion”, “bioma e ials”,
“biological d essing”, “clinical s udy”, “congeni al
de ec s”, “human amnio ic memb ane”, “paedia ic
wound”, “neona al wounds”, and “ egene a i e
medicine”. The Sea ch was ex ended by
snowballing he e e ence lis o all included
s udies. The inal analysis included one
expe imen al RCT, h ee e iew a icles, and
wel e case epo s. The expe imen al s udies we e
in a , pup, and po cine models. The paedia ic
second-and hi d-deg ee he mal bu n ollowed by
paedia ic ocula diseases iz co neal epi helial
ulce s, conjunc i a econs uc ion ollowing S e en
Johnson Synd ome, and sca ing a e su ge y o
s abismus we e he mos common indica ions o
he usage o AM. Fi e cases o meningomyelocele
epai (in adu al& ex adu al placemen o AM)
and 2 cases o gas oschisis epai (as an
an iadhesi e laye ) we e epo ed. F eeze-d ied
hAM is mos equen ly used in clinical p ac ice.
Au ologous HAM was used in an ena ally de ec ed
bi h de ec s. In he adul s, he esh hAM was
ound equally e ec i e as eeze-d ied AM, bu
wi h he isk o ansmission o con agious
diseases. The li e a u e on F esh amnion is
de icien in paedia ic pa ien s. HAM as a skin
subs i u e in paedia ic wounds/de ec s has shown
an enhanced a e o healing. Howe e , u he
s udies, ega ding he u ili y o hAM in he
managemen o paedia ic wounds, congeni al
ana omical de ec s, and diseases along wi h
analysis o ou come and economic cons ain s in
de eloping coun ies a e needed.
O agh a HA e al 26 (2023) explo e ha amnion
implan a ion in he ope a ing oom on child en's
acu e second deg ee bu n wounds in pa ien s
e e ed o Shahid Mo aha i Hospi al in Teh an in
2022-2023. S udy me hod: In his c oss-sec ional
s udy, which e ospec i ely examines he esul s o
amniocen esis in child en e e ed o Shahid
Mo aha i Hospi al in Teh an in 2022-2023, pa ien
eco ds a e examined o collec in o ma ion.
Findings: The in o ma ion o 203 child en unde 16
yea s o age who unde wen amniocen esis in
Shahid Mo aha i hospi al wi h 2nd deg ee bu ns
be ween 2022 and he end o Decembe 1401 we e
analyzed. Thei a e age age was 4.86±3.937.
59.6% o he subjec s we e boys and 40.4% we e
gi ls. The a e age du a ion o hospi aliza ion was
6.62±4.483 days. 96.1% o he bu ns happened a
home, 1.9% in he pa k and 1.5% in he s ee . The
equency o bu n pe cen age o pa ien s is 37.4%
in he ange o 10-19%, 29.1% in he ange o 20-
29%, 20.7% in he ange o 0-9%, 11.3% in he
ange o 30-39%, 1% in he ange o 40-49%. and
0.5% was in he ange o 50-59%. 64.5% o
child en wi h boiling wa e , 12.8% wi h ood, 7.9%
wi h gasoline, 4.4% wi h lames, 3% wi h alcohol,
2.5% wi h gas canis e s, 2% wi h ci y gas, 2% wi h
lammable ma e ials, 0.5% wi h coal. And 0.5%
we e bu ned by a ho objec . 75.4% o pa ien s had
unk bu ns, 68.5% had a m and o ea m bu ns,
50.7% had head and neck bu ns, 48.8% had high
and leg bu ns, 35% had hand bu ns, 12.8% had leg
bu ns, and 2% had whole body bu ns. 20.7% o
pa ien s needed g a ing du ing hospi aliza ion. Ou
o 131 people who su e ed scald bu ns, 27 people
needed g a ing. Ou o 26 people who su e ed
ood bu ns, 3 people needed g a ing. Ou o 16
people who we e bu ned wi h gasoline, 6 people
needed g a ing.
Kadi a M e al 27 (2023) showed ha
Ex a asa ion is leakage o ma e ial om a
pe iphe al enous access in o adjacen issue,
which esul s in issue damage anging om local
i i a ion o nec osis and sca o ma ion. Neona es
a e a ex a asa ion isk wi h IV ea men because
o hei small, agile eins and he long ea men
pe iod equi ed. In his epo , in es iga o s
assessed he e icacy o amnio ic memb ane (AM)
as a biological d essing o heal ex a asa ion
wounds in neona es.
This case se ies includes six neona es who
p esen ed wi h ex a asa ion inju ies om Feb ua y
2020 o Ap il 2022. Neona es bo n a any
ges a ional age diagnosed wi h a wound seconda y
o ex a asa ion we e ec ui ed. Neona es wi h skin
diso de s and hose who had s age 1 o 2 wounds
we e excluded. P o ide s co e ed in ec ion- and
nec osis- ee wounds wi h AM and assessed he
wounds a e 48 hou s. Fi e days a e placemen ,
p o ide s emo ed and eplaced he AM; hey
con inued o eplace he bandages e e y 5 o 7 days
un il healed. The a e age ges a ional age o
included neona es was 33.6 weeks. A e age
healing ime was 12.5 days ( ange, 10-20 days),
and no ad e se eac ions we e obse ed. All
neona es healed comple ely wi hou sca o ma ion.
This p elimina y epo sugges s ha he
applica ion o AM in ea ing ex a asa ion in
neona es is sa e and e ec i e. Howe e , con olled
ials wi h la ge sample sizes a e needed o
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Mukhe jee e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
164
e alua e his ou come and de e mine implica ions
o p ac ice.
Ing aldi AL e al 28 (2023) ound ha biological
issues om a ious ana omical sou ces ha e been
u ilized o issue ansplan a ion and ha e
de eloped in o an impo an sou ce o ex acellula
sca olding ma e ial o egene a i e medicine
applica ions. Tissue sca olds ideally in eg a e wi h
hos issue and p o ide a homeos a ic en i onmen
o cellula in il a ion, g ow h, di e en ia ion, and
issue esolu ion. The human amnio ic memb ane is
conside ed an impo an sou ce o sca olding
ma e ial due o i s 3D s uc u al a chi ec u e and
unc ion and as a sou ce o g ow h ac o s and
cy okines. This issue sou ce has been widely
s udied and used in a ious a eas o issue epai
including in ao al econs uc ion, co neal epai ,
endon epai , mic o ascula econs uc ion, ne e
p ocedu es, bu ns, and ch onic wound ea men .
The p oduc ion o amnio ic memb ane allog a s
has no been s anda dized, esul ing in a wide a ay
o amnio ic memb ane p oduc s, including single,
dual, and i-laye ed p oduc s, such as amnion,
cho ion, amnion–cho ion, amnion–amnion, and
amnion–cho ion–amnion allog a s. Since hese
allog a s a e no p ocessed using he same
me hods, hey do no necessa ily p oduce he same
clinical esponses. The aim o his e iew is o
highligh he p ope ies o di e en human allog a
memb anes, p esen he di e en p ocessing and
p ese a ion me hods, and discuss hei use in
issue enginee ing and egene a i e applica ions.
F anco PA e al 29 (2025) obse ed ha Non- a al
bu ns a e a global heal h issue wi h a conside able
impac on mo bidi y as well as aes he ic and
unc ional sequelae. Facial bu ns in neona es a e
a e and o en occu in hospi al se ings due o
medical de ices. Due o i s egene a i e po en ial,
he amnio ic memb ane has been used as an
al e na i e ea men o supe icial and pa ial-
hickness bu ns. This epo documen s he
success ul use o he amnio ic memb ane in
ea ing a hi d-deg ee bu n on he nasal ip o a
p e e m newbo n.
Case p esen a ion and A male newbo n a 33
weeks o ges a ion was admi ed o he neona al
ca e uni and p esen ed wi h a hi d deg ee bu n on
he ip, igh ala, and columella o he nose,
seconda y o he use o mal unc ion on he
empe a u e modula o o a en ila ion mask.
Ini ially, he use o hyd ogel and d essings wi h
Fi os imoline applied on he inju y helped o
pa ially elimina e he nec o ic issue, and hen an
amnio ic memb ane was placed on he inju y. The
8-mon h ollow-up showed adequa e
epi helializa ion wi hou nasal collapse and a
sa is ac o y aes he ic ou come we e obse ed,
al hough he e was a sligh loss o nasal ip
p ojec ion. This case epo demons a es he
e ec i eness o he amnio ic memb ane in he
healing p ocess o nasal bu ns in neona es by
imp o ing wound healing and con ibu ing o
ib osis educ ion, due o i s ichness in g ow h
ac o s and cy okines. I s an i-in lamma o y and
bac e ios a ic e ec s con ibu e o pain con ol and
educe mic obial p oli e a ion, op imizing aes he ic
ou comes. In combina ion wi h o he d essings, he
amnio ic memb ane p omo es neo ascula iza ion
and epi helializa ion p e en ing signi ican
de o mi ies. The amnio ic memb ane is an e ec i e
al e na i e o ea ing neona al acial bu ns,
minimizing issue damage and p ese ing nasal
ana omy. This case epo esul s highligh he
impo ance o a mul idisciplina y app oach in
ea ing acial bu ns, in eg a ing su gical echniques
and ad anced wound ca e echnologies o achie e
adequa e unc ional and aes he ic ou comes.
Howe e , long- e m ollow-up will es ablish he
need o addi ional p ocedu es and he e olu ion o
he nasal ana omy.
Jaba khyl D e al 30 (2025) explo e ha bu n
inju ies in he paedia ic popula ion a e common
and accoun o a subs an ial p opo ion o hospi al
a endances, leading o a g owing ocus on
op imising wound ca e o enhance healing, educe
discom o and minimise he need o equen
d essing changes. T adi ional d essings o
supe icial bu ns in child en ha e inhe en
limi a ions ha may hinde hese goals. Biob ane
(Dow Hickman/Be ek Pha maceu icals, Suga
Land, TX), a semi-pe meable silicone de ice
embedded wi h a nylon mesh and a po cine-de i ed
collagen ma ix, o e s a p omising al e na i e wi h
ad an ages such as imp o ed wound healing,
educed pain and ewe d essing changes. This
sys ema ic e iew and me a-analysis, conduc ed in
acco dance wi h P e e ed Repo ing I ems o
Sys ema ic Re iews and Me a-Analyses guidelines,
assessed he e icacy o Biob ane by analysing da a
om MEDLINE, PubMed, EMCa e, Coch ane
Coch ane Cen al Regis e o Con olled T ials and
addi ional clinical ial egis ies up o 8 June 2024.
P ima y ou comes included bu n wound healing
ime, hospi al leng h o s ay and in ec ion a e,
while seconda y ou comes assessed he need o
spli - hickness skin g a s (STSGs), pain and he
numbe o d essing changes. Da a syn hesis using
he Open Me a Analys so wa e (B own
Uni e si y, P o idence, RI) encompassed 781 bu n
wounds ac oss 12 s udies. The esul s showed ha
Biob ane signi ican ly sho ened wound healing
ime (mean di e ence, MD: 5.168 days, p = 0.001)
and hospi al leng h o s ay (MD: 2.009 days, p <
0.001) compa ed o s anda d d essings. The
in ec ion a e was compa able (odds a io, OR:
2.457, p = 0.132), and he e was no di e ence in
he equi emen o STSGs (OR: 0.965, p = 0.956).
This sys ema ic e iew and me a-analysis
demons a e ha Biob ane is an e ec i e ea men
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Mukhe jee e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
165
o supe icial paedia ic bu n inju ies, o e ing
as e wound healing, educed pain and sho e
hospi al s ays compa ed o adi ional d essings.
Discussion
The use o human amnio ic memb ane (AM) as a
biological d essing in paedia ic bu n ca e—
especially wi hin e ia y heal hca e se ups—
demons a es se e al clinically meaning ul
ad an ages o e con en ional me hods like sil e
sul adiazine (SSD), pa a in gauze, polyu e hane,
and ni o u azone-imp egna ed d essings.
Fi s , AM signi ican ly educes hospi al s ay and
d essing change equency, enhancing pa ien
com o and dec easing ca egi e wo kload. In a
e ia y cen e s udy o paedia ic scald bu ns, ea ly
AM applica ion led o ma kedly sho e admissions
and ewe d essing changes; no ably, none o hese
pa ien s equi ed g a ing, in con as o he we
collagen and pa a in gauze g oup [31]. In a
andomized ial in ol ing 102 child en (ages 1 day
o 12 yea s) compa ing adia ion s e ilized AM o
SSD, AM was associa ed wi h signi ican ly sho e
hospi al s ays, ewe d essing changes, and as e
epi helializa ion o bo h supe icial and deep
second deg ee bu ns; mo eo e , AM was painless,
well accep ed by bo h pa ien s and ca egi e s, and
easy o physicians o apply [32].
Secondly, wound healing ou comes a e consis en ly
supe io wi h AM. A 2025 sys ema ic e iew and
me a‑analysis encompassing 11 ials (n = 971)
epo ed ha AM signi ican ly sho ened mean
healing ime, enhanced wound healing a es,
lowe ed in ec ion incidence, and educed d essing
enewal equency compa ed o con ols [33]. A
b oade me a-analysis o 11 andomized con olled
ials ac oss a ious d essings (including SSD and
polyu e hane) ea i med ha AM ou pe o med
con en ional d essings in healing e icacy, hough
honey showed e en g ea e e ec i eness [34].
Thi dly, when compa ed wi h SSD oin men , AM
demons a ed supe io pe o mance in a ecen
open-label andomized ial ocused on
second‑deg ee he mal bu ns. By days 7, 14, and
30, pa ien s ea ed wi h AM expe ienced
signi ican ly be e epi helializa ion, educed
sca ing and pigmen a ion, less pain, and sho e
hospi al s ays, hough a a highe ea men cos
($170 s $71) [35].
Beyond immedia e healing me ics, AM o e s
addi ional biological and mechanis ic bene i s.
Compa ed wi h bioenginee ed skin subs i u es,
p opensi y sco e–ma ched analyses sugges ha
AM may educe hype ophic sca ing, wound
dehiscence, local in ec ions, and pos ope a i e
pain, likely due o i s ich composi ion o g ow h
ac o s, cy okines, ex acellula ma ix p o eins,
and immunomodula o y molecules ha suppo e-
epi helializa ion, modula e TGF-β signaling,
p omo e M2 mac ophage esponse, and p o ide
sca olding o cell mig a ion [36].
AM has also been success ully applied o spli -
hickness skin g a dono si es, wi h s udies
showing as e healing, educed pain and ewe
d essing changes, and equal o be e cosme ic
ou comes compa ed o con en ional d essings like
Vaseline gauze. These indings we e consis en
ac oss andomized ials and sys ema ic e iews
[37][38]. Roy I e . al obse ed ha apa om
child en, in adul s also eshly collec ed amnio ic
memb ane applica ion has been ound o modula e
in lamma o y s a us and a quick ansi ion om an
in lammed, non-healed wound bed o a ma u e,
epi helialized and emodeled issue. [33]
Las ly, AM d essings ha e been gene ally sa e,
wi h no documen ed ad e se eac ions o disease
ansmission in he e iewed li e a u e [34].
Howe e , highe cos emains a po en ial ba ie , as
highligh ed in compa a i e s udies wi h SSD [35].
Conclusion
In conclusion, amnio ic memb ane d essings o e
signi ican clinical ad an ages o e con en ional
d essing me hods in he managemen o pedia ic
bu n ulce s wi hin e ia y heal hca e se ings. Thei
inhe en an i-in lamma o y, an imic obial, and
egene a i e p ope ies con ibu e o as e healing,
educed pain, and dec eased equency o d essing
changes, which a e pa icula ly bene icial in
pedia ic ca e. While adi ional me hods emain
widely used due o a ailabili y and amilia i y, he
g owing body o e idence suppo s he in eg a ion
o amnio ic memb ane he apy as a sa e, e ec i e,
and child- iendly al e na i e. Fu he la ge-scale,
con olled s udies a e wa an ed o s anda dize
p o ocols and enhance accessibili y, ensu ing
op imal ou comes in pedia ic bu n ca e.
Re e ences
1. F anco PA, Espino SM, Díaz MP, Pa a JD.
Bu ns Open. (2025).
2. Chak abo y SK, Rashid HO, Gomes DJ.
P ocessing and Use o Radia ion S e ilized
Human Amnio ic Memb ane Allog a s as
Biological D essings o Wounds in Child en:
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