Introduction: Treatment of facial burn wounds is especially challenging due to the severe physical and psychological impact on patients. Application of amniotic membrane skin substitutes in treatment of burn wounds has shown promise due to its potential for improved re-epithelialization and healing of the wounds while decreasing infection and scarring. The unique properties of this skin substitute may suggest an effective option in treatment of burn wounds on the face.

Methods: A retrospective review of a burn registry at a level 1 trauma center with an ABA credited burn unit was performed over a 2- year period. Records of patients with diagnosis of burn wounds involving the face in whom amniotic membrane skin substitute was used in surgical setting were screened. Patients with minimum of 6 months of complete follow-up data were included. Outcome variables included hypertrophic scar formation, post-treatment complications, scar pliability and vascularity, number of applications, infection, need for autografts, need for laser scar resurfacing, or secondary corrective surgeries. Vancouver scale was used to evaluate scar outcomes.

Results: A total of 30 burn patients met our inclusion criteria. A total of 15 patients were lost to follow up or did not have complete evaluation of outcomes, therefore not included in the data set. The average time of follow up is 64.2 days, ranging from 7 to 411 days. The age range of the patient population was 21-85 (average age 44). Average TBSA is 7.3%, ranging from 1.5%-30%. Twenty-two patients were male, and 8 patients were female. Out of 30 patients, 4 had 3rd degree burns and 26 had 2nd degree burns. Third degree burns averaged 1.75 applications of the substitute and 2nd degree burns averaged 1.04 applications of the substitute. Overall, the burn wounds healed with favorable scarring with an average score of 1.2 on Vancouver scale with minimal difference between 2nd and 3rd degree wounds (average of 1.19 and 1.25 for 2nd degree and 3rd degree respectively). Minimal variability was noted with the extent of the burn wounds and age with slight worsening with greater involvement and advanced age (TBSA) <5%, 5-20%, and 20%<, , with average scores 1.10, 1.09, and 1.33 respectively; age groups 21-40, 41-60, and over 60 years of age with average scores of 1.10, 1.21, and 1.33 respectively). No secondary corrective procedure was performed.

Conclusion: Amniotic membrane skin substitute may serve as an effective tool in the treatment of facial burn wounds. We found minimal differences in overall outcomes related to extent and depth of the burn or age of the patient. Yet, further studies with more data can pave the way for effective use of this skin substitute in burn patients.