Surgical Handling of Cryopreserved Amniotic Membrane

Handling Cryopreserved Amniotic Membrane

Cryopreserved amniotic membrane is semi-transparent and is resilient to stretching or tearing. To help orient the membrane during clinical use, the tissue's sticky stromal side is manufactured attached to the carrier paper. This carrier paper is enclosed in a dualpouch system (A) and shipped in a temperature controlled shipping container.

In the operating room, the circulating nurse peels open the foil pouch (B), while the scrub nurse retrieves a clear plastic bag from inside using sterile smooth forceps or gloves to remove the inner pouch containing the tissue (C). The clear inner pouch may be introduced to the sterile field. Using sterile scissors, cut below the sealed line of the inner pouch and remove the tissue and carrier paper using smooth sterile forceps (D).

 

 

 

 

 

Removing Cryopreserved Amniotic Membrane from the Carrier Paper

During surgery, the orientation of AmnioGraft® should be “the sticky stromal side down” if it is used as a permanent graft.  If multiple layers are used, the orientation of the bottom layer(s) does not matter; only the orientation of the top membrane needs to be “sticky stromal side down”. The following methods can be used to ensure such an orientation.

 If an assistant is available, the surgeon may use two 0.12 forceps to grab the two corners of the membrane while the assistant retrieves the backing support from the surgeon (E). By keeping the two forceps apart, the surgeon can ensure that the sticky stromal side (facing the backing support) is placed down on the area to be grafted.

If an assistant is not available, the surgeon may use one 0.12 forceps to grab the backing support while a dry surgical sponge or 0.12 forceps are used to peel off the membrane gradually from one side until 3 to 5 mm of the remaining membrane is still adhered to the backing support. The backing paper is then flipped so that the membrane is underneath and the semi-detached membrane is flattened on the eye. This ensures the sticky stromal side is facing down on the area to be grafted.

Confirming Amniotic Membrane Orientation

If the orientation becomes questionable, the following method can be used to verify the desired orientation:

  • Spread the membrane so that it is flat.
  • Take a dry surgical applicator and approach the membrane vertically from above.
  • If the tip catches the membrane, the sticky stromal side is UP (F).
  • If the tip does not catch the membrane, the sticky stromal side is DOWN (G).

 

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If you have additional surgical questions after viewing this information, contact OSREF’s Research Director, Scheffer C.G. Tseng, MD, PhD, by e-mail at stseng@ocularsurface.comor by phone at 305-274-1299.

Financial Interest Disclosure: Dr. Tseng and his family are more than 5% shareholders in TissueTech, Inc. and Bio-Tissue, Inc. which currently distributes AMNIOGRAFT® and PROKERA®

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