Comparing Amniotic Membranes to Other Bioengineered Skin Substitutes in Wound Healing: A Propensity Score-Matched Analysis

<b>Background/Objectives</b>: The amniotic membrane, which is widely available and inexpensive, has received recent attention for its potential applications in wound healing. This is the first study to use a large database to examine the efficacy of amniotic membrane grafting compared to other skin substitutes. <b>Methods</b>: The TriNetX electronic health database was queried in October 2024 for patients with burns or chronic skin ulcers. Patients were stratified by treatment with amniotic membrane grafts or another skin substitute. These patients were then 1:1 propensity score-matched based on age, demographics, and comorbidities. Group differences were assessed with risk ratios and <i>p</i>-values. <b>Results</b>: A total of 557 patients remained in each group after propensity score matching. Patients who were treated with amniotic membrane grafts had significantly decreased hypertrophic scarring (1.7% vs. 6.2%, <i>p</i> < 0.0001), local skin infections (17.4% vs. 29.9%, <i>p</i> < 0.0001), and acute postoperative pain (3.7% vs. 7.8%, <i>p</i> = 0.003). Additionally, subsequent split-thickness skin grafting was utilized significantly less after amniotic membrane grafts. When compared to skin substitutes for large wounds (>100 cm²), the advantages of amniotic membrane were even more pronounced. <b>Conclusions</b>: This multi-institutional study supports amniotic membranes as a viable alternative to conventional bioengineered skin substitutes. Further research should evaluate amniotic membranes in wound beds of different sizes to better characterize their use in preparation for or as an alternative to skin grafting itself.