Eighteen-months old Raju (name changed) screamed with pain when boiling dal fell on him. His tender skin - half his body - had suffered second-degree burns. Panic-stricken parents rushed him to Mumbai's known plastic surgeon Dr Kalpesh Gajiwala.
After cleaning the wound and removing the dead skin, Dr Gajiwala placed the transparent biological dressing ‘ Amnion' directly on the wound. The transparent thin dressing stuck easily to the oozing surface and sealed it completely . It automatically peeled off after the wound had healed. The child was saved from the trauma of daily dressing.
In the words of Dr Kalpesh who uses amnion quite extensively either in preparing the burn wounds for a skin graft or to help heal the sites from which a skin graft has been taken says, "It helps in faster healing and causes much less scarring."
Perhaps there can't be a better recycling of "after birth waste."
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al. And it is available in ‘ready to use' packs at India's only ISO 9001:2000 certified Tissue Bank of Tata Memorial Hospital.
As of now the hospital recovers this precious after birth waste from the two maternity hospitals in its vicinity to be processed; freeze dried, sterilised by gamma radiation and packaged. As amnion dressings are stored at room temperature, packets are easily mailed anywhere in the country .
Unfortunately this amazing membrane is going waste in the rest of the city and country. The solution lies in setting up a national bank. As its production is directly linked to the childbirth, the raw material availability will never be a problem in a country that is battling to arrest the birth rate. Only the donors will have to come forward as their consent is required even though it is a discarded tissue.
"The donor has to know its specific use and also give consent for the testing of the do- nated blood sample for HIV Hepatitis , etc," says Dr Astrid Lobo Gajiwala, head of the Tissue Bank. As many as 5,00,000 patients are treated in United States every year with amnion.
The biological wound dressing can be used on any part of the body. The largest size available is 20X20cms and smallest is 4X4cms. It sticks like a stamp, seals off the wound and peels off as the wound heels. Its cheap, it's transparent, and is usually preferred as it mimics the skin. Analgesic use is also reduced, as there is almost imme- diate pain relief.
Sharing his own experience A Bakhru said "I suffered serious burns during Diwali festivities in November last. My hand was badly burnt while I was lighting a flower mountain with a sparkler. I was rushed to the hospital where the doctor treated me. I haven't had normal dressing. Amnion dressing came as a big relief as there was no need to clean the wound every two days or suffer the pain during the removal of the bandage after seven days of surgery . Pain is something that makes you insane with burns and burns dressing.
Amnion made it easy - a lifesaver for people with high percentage of burns."
Dr Astrid Lobo Gajiwala, who set up the Tissue Bank in collaboration with the International Atomic Energy Agency UN says, "There is a need to de , velop a national amnion bank to recycle the discarded after birth waste. The aim should be to make the biological dressing available on demand. We have helped in starting amnion banks at Jodhpur. Recently we also trained staff from a private hospital in Gujarat."
Besides the internal use, the TMH has couriered ‘ready to use' packs all over the country "People are aware but . not enough. We need to increase awareness as well as the supplies. It would surely be a big boon if more surgeons used it especially for burns patients. Currently we also supply amnion to ophthalmic surgeons all over the country," says Dr Astrid. However the demand is much more than the supplies. Between February 2007 and 2008 TMH had 1014 donors, of whom 23 per cent were rejected after tests.
According to doctors at the TMH amnion proved to be particularly valuable in the management of moist skin ulceration in radiation therapy patients. Such ulcers are often difficult to treat in areas like groin. Amnion adheres easily to the irregular contours, does not require to be changed frequently, reduces pain and enhances healing. It has proved to be more efficacious and cost effective than routine dressings.
Dr Astrid who is also the vice president of the Asia-Pacific Association of Surgical Tissue Banks says, "Amnion dressings were especially useful in Asia where religious barriers still exists making porcine or bovine skin unacceptable. Though there are synthetic skin substitutes available in the market, people find it expensive. They are also not acceptable as materials of porcine or bovine origin are used."
Dr Kalpesh cites the case of one Shanti (name changed) who took some pills for fever. The chemical reaction of the pills left burn-blisters all over her body . She was rushed to the hospital in great agony To the relief of the patient he used . amnion instead of normal dressing.
Doctors find it most useful for patients undergoing radiation therapy . "We were trying different treatments for radiation reaction on the skins, especially in cases of breast cancer when we came to know about amnion. We used it on patients and the response was good. Healing was faster, the application was easy and was inexpensive too. As it stayed longer than the normal dressing, the patient too found it less painful.
Though now with better equipments the reaction too is less, but whenever there is one we prefer using amnion. It works very well," said Dr SK Srivastava, head of Radio Therapy department at the TMH. Amnion is also helpful in cases of radiation ulceration especially in the groin folds and in the natal cleft. As the area remains wet because of perspiration, patients often develop skin pigmentation. It is essential to treat ulceration to locally control cancer. In such cases amnion is useful as it adheres to the wet skin also.
Now amnion is being used in orbital and ocular surface reconstruction to restore sight following injury and disease.