Application of Dehydrated Amniotic Membrane Allografts in Advanced Diabetic Foot Ulceration: Case Report and Review of Literature
Round 1
Reviewer 1 Report
The authors used human amniotic dehydrated allografts for the treatment of DFU. The only one patient treated received weekly new allografts and healing occurred in less than seven weeks. This is an important outcome, as DFU patients are at a high risk now, not only because of slow-to-heal, but also because of microbial contamination. The work is worthy to be shared with the public.
There are minor comments below for the authors to be addressed:
1. What was the reason for choosing placenta only from patients with C-section? Why not from those with natural giving-birth? Can you comment your choice please? This is definitely an interesting point.
2. What were the sizes of the allografts applied? How were applied the allografts? How did you hold them in place? Do you hydrate them upon application? Could you elaborate with more details please?
3 3. What was the behaviour of the grafts upon removal? Did they stick to the wound? How painful or not painful was it for the patient? This was not commented in the text.
4 4. Table 2. This is rather a scoring table, which is not commented in the text. In the text, you discuss about % while in the table, all numbers are as scores.
Author Response
Point 1. What was the reason for choosing placenta only from patients with C-section? Why not from those with natural giving-birth? Can you comment your choice please? This is definitely an interesting point.
Response 1. The reason for only using placentas from C-section births is to avoid maternal-fetal blood cross-contamination.
Point 2. What were the sizes of the allografts applied? How were applied the allografts? How did you hold them in place? Do you hydrate them upon application? Could you elaborate with more details please?
Response 2. These are the sizes of the grafts respectively, three 4 cm x 6 cm grafts, one 4 cm x 4 cm graft, one 3cm x 4 cm graft, one 2 cm x 3 cm graft, and one 2 cm x 2 cm graft. They were applied directly to the wound. No hydration is necessary. The grafts are made to readily adhere to the wound and stay in place.
Point 3. What was the behaviour of the grafts upon removal? Did they stick to the wound? How painful or not painful was it for the patient? This was not commented in the text.
Response 3. Since the graft incorporates itself into the exposed wound, it is not removed.
Point 4. Table 2. This is rather a scoring table, which is not commented in the text. In the text, you discuss about % while in the table, all numbers are as scores.
Response 4. See Appendix B, specifically Necrotic Tissue Amount and Epithelialization for percentages that correlate to scores listed on Table 2.
Reviewer 2 Report
This case study aims to report the efficacy of the application of dehydrated amniotic membrane allograft (DAMA) to a diabetic foot ulcer. And this case study demonstrates that the application of DAMA has the potential to augment the body’s natural DFU healing response.
The data and logic are very clear, and the presentation of the graphs makes it clear to the readers. This case report provides new directions and options for the rehabilitation of DFUs by introducing new materials. It is recommended to accept and publish.
Author Response
Thank you for your feedback!
