Healthcare professionals involved in treating acute or chronic wounds always aim to achieve optimal tissue repair within a reasonable time frame while keeping post-repair sequelae to a minimum. Among newer wound healing innovations is the use of placental tissue to aid wound repair. In this article, we will discuss the benefits and drawbacks of placental tissue in wound healing.

What is Placental Tissue?

Placental tissues are specialized tissues that appear at the onset of pregnancy and support and nourish a growing fetus during its development and maturity. These tissues are composed of unique cells with pro-growth materials and nutrients. Useful placental components include the following:

• Umbilical cord
• The placental disc
• The amniotic membrane
• Amniotic fluid

These tissues possess complex structures and are “immunologically privileged” a property that makes them viable candidates for advanced wound care.

What Makes Placental Tissue Useful In Tissue Repair?

The different types of tissues that form the placenta have been established to play various roles in wound healing. To begin with, placental tissues are immunologically privileged, which implies there is no risk of rejection when used in transplant or graft situations. This immunological non-selectivity makes placental tissue highly adaptable to various tissue repair scenarios. Further, placental tissues contain a complex mixture of extracellular matrix proteins, cytokines, cells, and other signaling molecules that collectively boost wound healing. These substances positively alter the wound environment and support optimal repair at each stage of the tissue repair process.

Sources of placental tissue for wound healing?

Human placental tissue is often discarded after birth as medical waste as it is no longer useful to the mother or new-born. Placental tissue can be sourced from healthcare facilities after consent for use is given by the parents. All major categories of placental tissues are useful as wound healing materials. Placental tissues are increasingly being used as allografts for boosting wound healing outcomes in patients with chronic wounds. These materials promote cell proliferation, and migration and also stimulate cytokine release from recruited fibroblasts, endothelial cells, and stem cells.

Amniotic Membrane Allografts

Human amniotic membrane allografts are currently being used in a variety of clinical scenarios to optimize wound healing. Amniotic membrane allografts are used in numerous dermal, surgical (obstetrics, general, and neurosurgery), and dental wound healing procedures to achieve a faster repair. The key properties of amniotic membranes that make them so useful in tissue healing processes is an abundance of growth factors, cytokines, and other signaling bio-molecules that stimulate rapid tissue repair. The application of an amniotic membrane graft to a wound site provides an extracellular membrane scaffold on which optimal re-epithelialization will occur. 

Benefits of placental tissue in wound healing

Placental tissues have become an established source of wound healing materials with use dating back to the early twentieth century. Placental tissue allografts have been used with significant benefits in surgery, the treatment of burns, chronic wounds, ophthalmology, and the management of diabetic foot ulcers. While all placental tissues have wound healing potential, the focus of most innovation in wound care has focused on the benefits/use of amniotic membrane allografts.

Limitations

Like with any other therapeutic intervention in wound healing, the use of placental tissues is not without its limitations. The major restrictions to the use of placental tissue in wound healing processes include  

• The cost of treatments
• Lack of sufficient data on therapeutic effectiveness
• Patients preferences
• Ethical concerns

Treatment Costs

Placental tissue therapies are not cheap to administer with amniotic materials costing several thousand dollars. This poses a big setback to its more widespread use as concerns over insurance coverage makes patients forego its use as a treatment option.

Lack of Sufficient Data on Effectiveness

Although the use of placental tissues in wound healing has been around for a while, the majority of the research and studies have been focused on amniotic membrane allografts. The field of placental tissue grafting is still growing so many patients are reluctant to try out these therapies without the presence of more extensive research on the subject. 

Patient Preferences

At the heart of every treatment protocol, is the issue of patient consent without which no treatment can be commenced. Despite its benefits, the use of placental tissues as a wound healing strategy will not be accepted by all patients with chronic wounds due to various reasons. Till clearer information dispelling doubts and assuring patients of the safety and suitability of these treatments, healthcare providers must continue to respect the wishes of their patients as long as they are deemed competent enough by law to make their own treatment choices.

Ethical Considerations

Various legal and ethical considerations are involved in the use of placental tissue therapies. Although the placenta is a human tissue thought to pose minimal concerns from an ethical viewpoint, its use still contributes to the general debate on the morality/legality of repurposing human tissues for commercial therapeutic purposes.