Document Type : Original Research Article


Department of Pediatric Surgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia.



Gastric perforation in neonates is a medical emergency with a 75% mortality rate. Several studies have been conducted to promote tissue healing, including using various surgical procedures and materials, including H-DAM technology. To compare the expression of Fibroblast Growth Factor (FGF) and Vascular Endothelial Growth Factor (VEGF) in gastric perforation repair employing H-DAM as a patch biomaterial to that of an omental patch in New Zealand white rabbits. This experiment was carried out on a New Zealand white rabbit model divided into three groups: amniotic membrane, omental patch, and primary repair. An incision was made wide with a depth of the entire gastric wall in the gastric corpus and the perforation repair was carried out. The repair is closed with the H-DAM in the amniotic group and using the omentum in the omental group. The expression of FGF and VEGF was used to evaluate the wound healing process. VEGF and FGF expression were higher in gastric perforation models sutured with H-DAM than in models without H-DAM. There were significant differences in the average expression of VEGF and FGF. Human-dried amnion has a role in the wound-healing process in gastric perforation repair models, hence H-DAM may be the a preferred repair strategy for gastric perforation.

Graphical Abstract

The use of human dried amniotic membrane (H-DAM) as a biomaterial patch for wound healing of gastric perforation viewed from the fgf and vegf


Main Subjects

[1] a) B. Barmadisatrio, A.S. Mulluzi, Delayed laparotomy and gastric repair in gastric perforation: a case report in the neonatal patient, Bali Medical Journal, 2021, 10, 43–46. [Crossref], [Google Scholar], [Publisher]‎; b) R. Karimi, M. Naseroleslami, R. Halabain, Ameliorative effect of crocin on cadmium-induced kidney neoplasms in rats,  International Journal of Advanced Biological and Biomedical Research, 2024, 12,  155-166.
[Crossref], [Publisher]‎; c) J.B. Puri, A.M. Shaikh, U.P. Dhuldhaj, Phytochemical and biochemical analysis of ajwain seed’s content, Eurasian Journal of Science and Technology2024, 4. [Crossref], [Google Scholar], [Publisher]‎; d) S. Rozmina, A. Bagheri Moghaddam, S.M. Sadrzadeh, V. Vakili, H. Zamani Moghaddam, M. Talebi Doluee, Comparison of the effects of ranitidine and pantoprazole on incidence of ventilator-associated pneumonia,  Eurasian Journal of Science and Technology, 20233, 67-72. [Crossref],  [Publisher]‎
[2] B.K.  Arora, R. Arora, A. Arora, Modified Graham’s repair for peptic ulcer perforation: Reassessment study, International Surgery Journal, 2017, 4, 1667. [Crossref], [Google Scholar], [Publisher]‎
[3] N.  Arai, H. Tsuno, M. Okabe, T. Yoshida, C. Koike, M. Noguchi, T. Nikaido, Clinical application of a hyperdry amniotic membrane on surgical defects of the oral mucosa, Journal of Oral and Maxillofacial Surgery, 2012, 70, 2221–2228. [Crossref], [Google Scholar], [Publisher]‎
[4] E.M. Kurniawati, B. Santoso, F.A. Rantam, B.I. Santoso, Widjiati, T.H.S. Hadi, G. Hardianto, H. Paraton, Does freeze dried amnion useful as scaffold for mesenchymal stem cell for repair of vesicovaginal fistula? An overview of proliferative and remodeling phase in the wound healing process, European Journal of Obstetrics & Gynecology and Reproductive Biology, 2022, 274, 113–116. [Crossref], [Google Scholar], [Publisher]‎
[5] A. Chopra, B.S. Thomas, Amniotic membrane: A novel material for regeneration and repair, Biomimetics Biomaterials and Tissue Engineering, 2013, 18, 1-8. [Crossref], [Google Scholar], [Publisher]‎
[6] J.C. Riboh, B.M. Saltzman, A.B. Yanke, B.J. Cole, Human amniotic membrane–derived products in sports medicine, The American Journal of Sports Medicine, 2016, 44, 2425–2434. [Crossref], [Google Scholar], [Publisher]‎
[7] M. Katoh, M. Katoh, FGF signaling network in the gastrointestinal tract (review), International Journal of Oncology, 2006, 29, 163–168. [Crossref], [Google Scholar], [Publisher]‎
[8] P. Larsson, C.I. Chamorro, A review on bladder wound healing after mechanical injury, Journal of Tissue Science and Engineering, 2016, 7, 10628. [Crossref], [Google Scholar], [Publisher]‎
[9] F. Zarei, M. Soleimaninejad, Role of growth factors and biomaterials in wound healing, Artificial Cells, Nanomedicine, and Biotechnology, 2018, 46, 906–911. [Crossref], [Google Scholar], [Publisher]‎
[10] H. Elkhenany, A. El-Derby, M. Abd Elkodous, R.A. Salah, A. Lotfy, N. El-Badri, Applications of the amniotic membrane in tissue engineering and regeneration: the hundred-year challenge, Stem Cell Research & Therapy, 2022, 13, 8. [Crossref], [Google Scholar], [Publisher]‎
[11] A.N. Prawoto, I. Dachlan, use of amniotic membrane for wound healing in burn injuries, Jurnal Rekonstruksi Dan Estetik, 2022, 7, 64–71. [Crossref], [Google Scholar], [Publisher]‎
[12] T. Brzozowski, P.C. Konturek, S.J. Konturek, D. Schuppan, D. Drozdowicz, S. Kwiecień, J. Majka, T. Nakamura, E.G. Hahn, Effect of local application of growth factors on gastric ulcer healing and mucosal expression of cyclooxygenase-1 and -2, Digestion, 2001, 64, 15–29. [Crossref], [Google Scholar], [Publisher]‎
[13] S. Oncel, M.D. Basson, Gut homeostasis, injury, and healing: New therapeutic targets, World Journal of Gastroenterology, 2022, 28, 1725–1750. [Crossref], [Google Scholar], [Publisher]‎
[14] A.T. Ramadhani, A. Setiawan, I.G.B.A. Hariastawa, Wound healing of gaster perforation with Human Dried Amniotic Membrane (H-DAM) as biomaterial patch viewing from the fibroblasts counts and collagen density, Bali Medical Journal, 2023, 12, 2378–2382. [Crossref], [Google Scholar], [Publisher]‎
[15] M. Song, W. Wang, Q. Ye, S. Bu, Z. Shen, Y. Zhu, The repairing of full-thickness skin deficiency and its biological mechanism using decellularized human amniotic membrane as the wound dressing, Materials Science and Engineering: C, 2017, 77, 739–747. [Crossref], [Google Scholar], [Publisher]‎
[16] A.S. Tarnawski, A. Ahluwalia, The critical role of growth factors in gastric ulcer healing: the cellular and molecular mechanisms and potential clinical implications, Cells, 2021, 10, 1964. [Crossref], [Google Scholar], [Publisher]‎
[17] M.K. Jones, H. Kawanaka, D. Baatar, I.L. Szabó, K. Tsugawa, R. Pai, G.Y. Koh, I. Kim, I.J. Sarfeh, A.S. Tarnawski, Gene therapy for gastric ulcers with single local injection of naked DNA encoding VEGF and angiopoietin-1, Gastroenterology, 2001, 121, 1040–1047. [Crossref], [Google Scholar], [Publisher]‎
[18] S. Barrientos, O. Stojadinovic, M.S. Golinko, H. Brem, M. Tomic‐Canic, Perspective article: Growth factors and cytokines in wound healing, Wound Repair and Regeneration, 2008, 16, 585–601. [Crossref], [Google Scholar], [Publisher]‎
[19] A. Gawryluk, B. Noszczyk, Properties and clinical application of human amniotic epithelial cells (HAEC), Current Gynecologic Oncology, 2015, 13, 123–135. [Crossref], [Google Scholar], [Publisher]‎
[20] T.J. Koob, J.J. Lim, M. Massee, N. Zabek, R. Rennert, G. Gurtner, W.W. Li, Angiogenic properties of dehydrated human amnion/chorion allografts: therapeutic potential for soft tissue repair and regeneration, Vascular Cell, 2014, 6, 10. [Crossref], [Google Scholar], [Publisher]‎
[21] J. Oba, M. Okabe, T. Yoshida, C. Soko, M. Fathy, K. Amano, D. Kobashi, M. Wakasugi, H. Okudera, Hyperdry human amniotic membrane application as a wound dressing for a full-thickness skin excision after a third-degree burn injury, Burns & Trauma, 2020,  8, 14. [Crossref], [Google Scholar], [Publisher]‎
[22] Y. Duan-Arnold, T.E. Uveges, A. Gyurdieva, A. Johnson, A. Danilkovitch, Angiogenic potential of cryopreserved amniotic membrane is enhanced through retention of all tissue components in their native state, Advances in Wound Care (New Rochelle), 2015, 4, 513–522. [Crossref], [Google Scholar], [Publisher]‎
[23] Y.A. Pratama, L. Zarasade, B.S. Nata’atmaja, A.R. Nurdianto, Comparison of freeze dried human amniotic membrane and its combination with platelet rich fibrin for the epithelial acceleration in an acute wound excision using Rattus Novergicus study model, Bali Medical Journal, 2023, 12, 1198–1203. [Crossref], [Google Scholar], [Publisher]‎