**The Use of Amniotic Membrane in the Management of Complex Chronic Wounds The Use of Amniotic Membrane in the Management of Complex Chronic Wounds**

Gregorio Castellanos, Ángel Bernabé‐García, Carmen García Insausti, Antonio Piñero, José M. Moraleda and Francisco J. Nicolás Gregorio Castellanos, Ángel Bernabé‐García, Carmen García Insausti, Antonio Piñero, José M. Moraleda and Francisco J. Nicolás

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/64491

#### **Abstract**

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414 Wound Healing - New insights into Ancient Challenges

Chronic wounds do not follow the usual wound healing process; instead, they are stuck in the inflammatory or proliferative phase. This is particularly evident in large, massive wounds with considerable tissue loss, which become senescent and do not epithelial‐ ize. In these wounds, we need to remove all the factors that prevent or delay normal wound healing. After that, soft tissue granulation is stimulated by local negative pressure therapy. Lastly, after the granulation is completed, the epithelialization process must be activated. Although a plethora of wound dressings and devices are available, chronic wounds persist as a unresolved medical concern. We have been using frozen amniotic membrane (AM) to treat this type of wounds with good results. Our studies have shown that AM is able to induce epithelialization in large wounds that were unable to epithelialize. AM induces several signaling pathways involved in cell migration and/or proliferation. Among those, we can highlight the mitogen‐activated protein kinase (MAPK) and Jun N‐terminal kinase (JNK) signaling pathways. Additionally, AM is able to selectively antagonise the anti‐proliferative effect of TGFß by modifying its genetic program on keratinocytes. The combined effect of AM on keratinocytes, promoting cell proliferation/migration and antagonising TGFß‐effect, is the perfect combination allowing chronic wounds to progress into epithelialization.

**Keywords:** soft‐tissue chronic wounds, amniotic membrane, TGF‐β, epithelialization

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
