The Tissue Structure in the Remodeling Phase of a Vesicovaginal Fistula between the use of Freeze-Dried Amnion and Primary Suturing in Rabbit

Background: One of the complications of gynecological and obstetric procedures is a vesicovaginal fistula. Surgery is the gold standard but the success rate has not yet reached 100%. The wound healing process needs to be supported by certain ingredients such as regenerative medicine. Amnion is easy to find and rich in growth substances. Aim: This study analyzed the comparison of tissue structure in the remodeling phase of the vesicovaginal fistula between the use of freeze-dried amnion and primary suturing on day 21. Materials and Methods: This experimental study used New Zealand rabbits which were female and weighed 3-4.5 kg. The first stage of the study created a model of a vesicovaginal fistula. The second stage of the study closed the vesicovaginal fistula which was successfully created in the first stage. The study used a post-test-only control group design. The histological examination included fibroplasia, angiogenesis, re-epithelialization, and collagen deposition on day 21. Data were analyzed descriptively and statistically. Results: The mean scores of angiogenesis, fibroplasia, re-epithelialization, and collagen deposition in a New Zealand rabbit model of vesicovaginal fistula sutured with human amniotic stem cell seeding were higher than rabbits without amniotic stem cell seeding, the stem cell injection group, and the control group. There was a significant difference between groups only in angiogenesis at day 21. Conclusion: Freeze-dried amnion plays a role in the wound healing process, especially in angiogenesis in the vesicovaginal fistula repair model. The use of freeze-dried amnion can be applied to assist the wound healing process in patients but still needs to be studied in humans.