human amniotic membrane consists of an epithelial monolayer , a thick basement membrane , and an avascular connective tissue matrix . the first use was in 1910 and then subsequently utilized in a variety of reconstruction procedures , as a surgical dressing and in treatment of diabetic and burn wounds . concerns about possible transmission of disease led to abandonment of human amniotic tissue through the 1980s . its use regained popularity followed reassurance of clinical safety , extending to use in ocular surface disease and spine surgery [ 25 ] . literature review provided no references of human amniotic membrane used as a biologic dressing to aid reconstruction of the nose . evidence demonstrating efficacy in epithelialization and pain reduction along with anti - inflammatory and anti - scarring properties pointed to human amniotic membrane as an ideal option for nasal reconstruction [ 68 ] . this case report presents a patient in which dehydrated human amniotic membrane ( epifix ; mimedex group , inc . , kennesaw , ga ) was used to facilitate healing of the lower third of the nose . a 56-year - old male presented status post assault with human bites to the tip of his nose , left ala , right ear and first digit of his left hand . physical exam revealed a well - developed , well - nourished adult caucasian male in no acute distress . there was a 22    18 mm full thickness skin and subcutaneous tissue defect present on the nasal tip . nasopharyngoscopy with a zero degree nasopharyngoscope revealed a slight right septal deviation without evidence of intranasal trauma , discharge or mucosal bleeding . involvement of the patient 's right auricular pinna was very superficial and treatment was deferred . no facial lacerations , bony abnormalities or palpatory tenderness was appreciated . facial weakness and neurologic deficits bilateral involvement of the hands and upper extremities also appeared very superficial and treatment was deferred . debridement of the nasal tip and adjacent structures was performed using standard sterile technique and local anesthesia . the defect measured 25    20 mm following debridement and the perichondrium and nasal cartilage was confirmed intact and without evidence of disease or injury . dehydrated human amniotic membrane was fashioned to the dimensions of the defect and affixed to the wound . sterile wet to dry dressing was applied and the patient was instructed to avoid recurrent trauma to , and washing of , the graft site . the patient was instructed to maintain a wet to dry dressing over the graft site at all times and to avoid displacement of the amniotic graft during dressing changes . the patient returned on postoperative date # 3 ( pod # 3 ) for wound check . the amniotic graft was undisturbed from initial placement and the wound bed was moist and clean . patient provided wet to dry dressing changes continued for another 4 days at which time a simple bandage was applied . the patient did not require medical assistance for wound care which included twice daily wet to dry dressing changes for 7 days postoperatively . incorporation of the graft matrix at 7 days postoperatively was considered sufficient to defer further wet to dry dressing changes with conversion to simple bandage coverage with daily changes . this case suggests that dehydrated human amniotic membrane provides an alternative to local tissue transfer and skin grafting for traumatic injuries involving the nose . other studies have demonstrated dehydrated human amniotic membrane to be effective as an allograft in ocular surface reconstruction and in healing chronic wounds and burns [ 25 , 9 ] . cytokines within the extracellular matrix include epidermal growth factor , keratinocyte growth factor , transforming growth factor and basic fibroblast growth factor . several theories have been proposed to explain the anti - inflammatory effect of human amniotic membrane including down - regulation of transforming growth factor beta signaling , suppression of pro - inflammatory cytokines , and reduced polymorphonuclear cell infiltration and subsequent keratinocyte death [ 58 ] . application of dehydrated human amniotic membrane appears a cost - effective strategy for treating wounds involving of the nose not involving the cartilage and perichondrium when compared to reconstruction with local or regional tissue transfer . dehydrated human amniotic membrane grafts can be applied using local anesthesia and avoiding the costs and risks associated with intravenous sedation or general anesthesia . application of dehydrated human amniotic membrane grafts are a simple single - stage procedure for treatment of the wound demonstrated in this case report . pedicled tissue transfer by contrast is a minimum two - stage procedure and skin grafting entails donor site morbidity and possible complications . dehydrated human amniotic membrane appears to be a simple , efficacious , cosmetically acceptable and cost - effective strategy for treating traumatic wound of the nose without cartilage or perichondrium involvement . future studies are warranted to compare the dehydrated human amniotic membrane to local tissue transfer , skin grafting and healing by secondary intention .
variations in skin thickness and contours pose significant challenges to reconstruction of the lower third of the nose . human amniotic 
 membrane allograft offers a potential alternative to tissue transfer in reconstruction of the lower third of the nose . 
 we reviewed the procedure and photographs of a healthy 56-year - old male with a 22    18 mm lower third nasal defect involving full thickness skin and subcutaneous tissue . 
 following preparation for grafting , dehydrated human amniotic membrane was fashioned to the dimensions of the defect and applied . 
 no further surgical intervention was provided for 3 months . 
 complete re - epithelialization of the nasal and adjacent defects was achieved with minimal scar formation . 
 human amniotic membrane allograft provides an efficacious and cosmetically acceptable alternative to local and regional tissue transfer .