Skin Graft With Amniotic Membrane: Case Report of the Sandwich Technique in a Burn Hand

Deep burns of the hand represent a major reconstructive challenge due to the critical functional role of the hand and the high risk of long-term disabling sequelae. The "sandwich" technique, combining an autologous skin graft with an amniotic membrane, has been described as a biological dressing with potential anti-inflammatory and wound-healing properties. A 32-year-old woman presented with a full-thickness burn involving the right palm and wrist after contact with an industrial thermal press. Following eschar excision, a full-thickness skin graft was harvested from the inner region of the ipsilateral arm; the donor site was closed primarily by advancing the wound edges with absorbable monofilament intradermal sutures and covered with Micropore tape to reduce tension. Because of incomplete well-vascularized perfusion of the recipient bed and the risk of functional impairment, an amniotic membrane was placed as an additional protective layer over the graft. By the seventh postoperative day, the graft showed satisfactory take, with no evidence of infection. At 12 months of follow-up, complete integration was achieved, with preserved joint mobility and a favorable aesthetic outcome. This case illustrates the technical feasibility of using preserved amniotic membrane as an overlay biological dressing over a full-thickness skin graft in a functionally critical palmar burn. Although satisfactory healing was observed, no causal conclusion can be drawn regarding improved graft integration, scar modulation, or functional preservation based on a single case. Further comparative studies are needed to determine whether the benefits reported in other grafting contexts also apply to full-thickness skin grafting.