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Perussolo J, Calciolari E, Dereka X, Donos N. Platelet-rich plasma and plasma rich in growth factors in extra-oral wound care. Periodontol 2000 2024. [PMID: 39056422 DOI: 10.1111/prd.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/23/2024] [Accepted: 04/15/2024] [Indexed: 07/28/2024]
Abstract
This narrative review evaluates the existing literature on the clinical efficacy and safety of platelet-rich plasma (PRP) and plasma rich in growth factors (PRGFs) in extra-oral wound care, considering their potential benefits and drawbacks. The review specifically focuses on the impact of these treatments on patients' quality of life, pain management, treatment costs, recurrence rates, and potential complications. Given the extensive literature and diverse range of extra-oral wound types in which these autologous platelet concentrates have been applied, this narrative review focuses on the most frequently described wound types, including diabetic foot ulcers, venous leg ulcers, pressure ulcers, surgical wounds, and burns. The use of PRP has been reported in various medical specialties, with a low risk of adverse events. While there is a growing interest in the use of PRGF with promising results, the available literature on this topic is still limited. Only a few studies evaluated patients' perception of the treatment and the relationship between treatment costs and clinical outcomes. Data on recurrence rates and complications also vary across studies. In conclusion, PRP and PRGF show promise as alternatives or as adjunctive therapies to conventional treatments for various extra-oral wounds and ulcers, leading to reduced wound size and accelerated healing time but should be considered on a case-by-case basis, taking into account the type and severity of the wound.
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Affiliation(s)
- Jeniffer Perussolo
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Medicine and Surgery, Dental School, University of Parma, Parma, Italy
| | - Xanthippi Dereka
- Department of Periodontology, School of Dentistry, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Ye Z, Chen H, Qiao Y, Wu C, Cho E, Wu X, Li Z, Wu J, Lu S, Xie G, Dong S, Xu J, Zhao J. Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2410134. [PMID: 38728032 PMCID: PMC11087838 DOI: 10.1001/jamanetworkopen.2024.10134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Platelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial. Objective To compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection. Design, Setting, and Participants This surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023. Interventions Participants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule. Main Outcomes and Measures The primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months. Results Among the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, -2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection. Conclusions and Relevance In this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000040262.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiang Chen
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eunshinae Cho
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlong Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang P, Cai F, Li Y, Yang X, Feng R, Lu H, Bai X, Han J. Emerging trends in the application of hydrogel-based biomaterials for enhanced wound healing: A literature review. Int J Biol Macromol 2024; 261:129300. [PMID: 38216016 DOI: 10.1016/j.ijbiomac.2024.129300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/01/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
Currently, there is a rising global incidence of diverse acute and chronic wounds, underscoring the immediate necessity for research and treatment advancements in wound repair. Hydrogels have emerged as promising materials for wound healing due to their unique physical and chemical properties. This review explores the classification and characteristics of hydrogel dressings, innovative preparation strategies, and advancements in delivering and releasing bioactive substances. Furthermore, it delves into the functional applications of hydrogels in wound healing, encompassing areas such as infection prevention, rapid hemostasis and adhesion adaptation, inflammation control and immune regulation, granulation tissue formation, re-epithelialization, and scar prevention and treatment. The mechanisms of action of various functional hydrogels are also discussed. Finally, this article also addresses the current limitations of hydrogels and provides insights into their potential future applications and upcoming innovative designs.
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Affiliation(s)
- Peng Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Feiyu Cai
- Department of Burns and Plastic Surgery & Wound Repair Surgery, the Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yu Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xuekang Yang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Rongqin Feng
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - He Lu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xiaozhi Bai
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Juntao Han
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
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Chigurupati VS, Khanna S, Kumar S, Khanna R. Efficacy of platelet-rich plasma in alleviating split skin graft morbidities. J Cutan Aesthet Surg 2024; 17:50-54. [PMID: 38736856 PMCID: PMC11086927 DOI: 10.4103/jcas.jcas_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Introduction Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors. Aims and Objectives To assess the effect of PRP on split-thickness skin graft uptake and donor site healing. Materials and Methods In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group. Results Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing. Conclusion The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.
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Affiliation(s)
- Veda Samhitha Chigurupati
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Talei B, Ziai H. PHAT Lips and PHAT Face: Platelet Hybridized Adipose Therapy for Superficial Musculoaponeurotic System and Dermal Rejuvenation. Facial Plast Surg 2023. [PMID: 37816491 DOI: 10.1055/a-2188-8608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Platelet-rich plasma has been increasingly used for facial rejuvenation in conjunction with other modalities such as microneedling or on its own. Nanofat grafting to the face has also been utilized for skin quality improvements. Our group previously described the novel combined Platelet Hybridized Adipose Transplant (PHAT) technique for hair restoration. In this series, we describe our experience with the PHAT technique for lip and facial rejuvenation to improve the quality of facial skin and superficial musculoaponeurotic system, and enhancing surgical results.
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Affiliation(s)
- Benjamin Talei
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Hedyeh Ziai
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
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Rahimi K, Hosseinpour L, Balaneji SM, Goli R, Faraji N, Babamiri B. Large wound surgery of diabetic foot ulcer with Split-thickness skin graft (STSG), and maggot debridement therapy (MDT): A case report. Int J Surg Case Rep 2023; 104:107947. [PMID: 36822027 PMCID: PMC9978508 DOI: 10.1016/j.ijscr.2023.107947] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Diabetic foot ulcers (DFUs) as one of the complications of diabetes mellitus (DM) can lead to death. CASE PRESENTATION The present case reports a 56-year-old woman with an 11-year history of type 2 diabetes who has had left DFUs for two years. The patient had antibiotic-resistant DFUs her left foot, which were completely gangrenous and a superficial ulcer up and under her left foot. Despite the routine DFU care, the patient did not recover from DFU using standard methods. The patient was referred to our wound management team. DFU was treated and managed using split-thickness skin graft (STSG) and surgical debridement, maggot debridement therapy (MDT). After two months, the patient's DFUs healed, and he was discharged from our service in good condition. CLINICAL DISCUSSION DFU can lead to infection, amputation, and even patient death. Therefore, effective treatment methods are very important for managing DFUs. CONCLUSION This case report study was shown that the combined use of STSG, surgical debridement, and MDT is a safe and effective approach to improve the healing of DFUs and prevent foot amputation.
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Affiliation(s)
- Kamal Rahimi
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Leila Hosseinpour
- Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University of Tabriz, East Azerbaijan, Iran
| | - Sahar Majidi Balaneji
- Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University of Urmia, West Azerbaijan, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Behnam Babamiri
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
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Knightly N, Lee C, O’Brien L, Qayyum T, Hurley C, Kelly J. Role for platelet rich plasma as an adjuvant therapy in wound healing and burns. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Abstract
Background
Platelet rich plasma (PRP) contains high concentrations of growth factors. Intuitively, these were thought to be of potential benefit in healing of chronic wounds, skin grafts and graft donor sites. This was echoed in retrospective studies and an individual case basis but had not been randomized.
Methods
A systematic search was carried out by two individuals, independently, on the MEDLINE, EMBASE and COCHRANE databases, according to PRISMA guidelines. All data analysis and statistics was pooled and analysed using the Cochrane RevMan Software.
Results
Split thickness grafts have been described by numerous authors, but PRP use did not offer a significant advantage in graft take in pooled results (MD 5.83, 95% CI − 0.69 to 12.25, random-effects, p = 0.08). The analysis of included randomized controlled trials has shown favourable split-thickness skin graft donor site healing in the PRP group (MD − 5.55, 95% CI − 7.40 to − 3.69, random-effects, p = < 0.00001) compared to the control group. For carpal tunnel syndrome, the pooled results showed no difference in functional scores vs steroid injections (SMD − 0.68, 95% CI − 1.47 to 0.10, randomeffects, p = 0.09) or indeed splinting groups.
Conclusions
With the current body of evidence, we conclude that the use of PRP as an adjuvant therapy in skin grafts, burns, carpal tunnel surgery or scars cannot be rationalised. A potential use of PRP is in donor site management but the cost of this would be difficult to justify.
Level of evidence: Not ratable.
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Ali SS, Ahmad I, Khurram MF, Chaudhury G, Karad S, Tripathi S, Sharma A. The Role of Platelet-Rich Plasma in Reducing Pain, Pruritis, and Improving Wound Healing of Skin Graft Donor Site. Indian J Plast Surg 2022; 55:376-382. [PMID: 36683882 PMCID: PMC9859680 DOI: 10.1055/s-0042-1759502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Wound healing is a dynamic and complex process. Therefore, no single agent can efficiently mediate all aspects of the wound healing process. Split-thickness graft has become a workhorse of plastic surgery for wound or raw area cover. In this study, we evaluate the effectiveness of autologous platelet-rich plasma (PRP) on the donor site and its effect in pain, purities, and epithelization. Materials and Methods This is a prospective study. A total of 15 patients were included who underwent split skin grafting for burns, trauma, or post-tumor excision raw area. PRP was prepared using standard described procedure. The donor site raw area after harvesting split-thickness graft was measured and the surface area was divided into two equal halves. One half was dressed using PRP and the other half was dressed using paraffin gauze piece only. The dressings were changed weekly for 3 weeks. Observation We found significant reduction in severity of pain and pruritis in the PRP group as compared with control group. Epithelization was faster in the PRP group on day 7 and 14, but the overall healing time was nearly the same by day 21. The side-by-side dressing thus show a definite improvement in the post-split-thickness skin graft wound care and PRP as a good dressing alternative. Conclusion Autologous PRP is very effective adjuvant in management of skin graft donor site. Its role in relieving pain and pruritis over donor site significantly improves patient's discomfort postoperatively. It helps in early and painless wound healing. However, we recommend for larger clinical study for better understanding of the efficacy of this blood product.
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Affiliation(s)
- Sheikh Sarfraz Ali
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Imran Ahmad
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammed Fahud Khurram
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Gautam Chaudhury
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India,Address for correspondence Gautam Chaudhury, MCh Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim UniversityAligarh 202001, Uttar PradeshIndia
| | - Somnath Karad
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sudanshu Tripathi
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Aditi Sharma
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Tang Y, Wang H, Sun Y, Jiang Y, Fang S, Kan Z, Lu Y, Liu S, Zhou X, Li Z. Using Platelet-Rich Plasma Hydrogel to Deliver Mesenchymal Stem Cells into Three-Dimensional PLGA Scaffold for Cartilage Tissue Engineering. ACS APPLIED BIO MATERIALS 2021; 4:8607-8614. [PMID: 35005939 DOI: 10.1021/acsabm.1c01160] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The synthetic biodegradable polyester-based rigid porous scaffolds and cell-laden hydrogels have been separately employed as therapeutic modality for cartilage repair. However, the synthetic rigid scaffolds alone may be limited due to the inherent lack of bioactivity for cartilage regeneration, while the hydrogels have insufficient mechanical properties that are not ideal for load-bearing cartilage applications. In the present study, a hybrid construct was designed to merge the advantage of 3D-printed rigid poly(lactic-co-glycolic acid) (PLGA) scaffolds with cell-laden platelet-rich plasma (PRP) hydrogels that can release growth factors to regulate the tissue healing process. PRP hydrogels potentially achieved the effective delivery of mesenchymal stem cells (MSCs) into PLGA scaffolds. This hybrid construct could obtain adequate mechanical properties and independently provide MSCs with appropriate clues for proliferation and differentiation. Real-time gene expression analysis showed that PRP stimulated both chondrogenic and osteogenic differentiation of MSC seeding into PLGA scaffolds. Finally, the hybrid constructs were implanted into rabbits to simultaneously regenerate both articular cartilage and subchondral bone within osteochondral defects. Our findings suggest that this unique hybrid system could be practically applied for osteochondral regeneration due to its capacity for cell transportation, growth factors release, and excellent mechanical strength, which would greatly contribute to the progress of cartilage tissue engineering.
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Affiliation(s)
- Ying Tang
- Key Lab of Biobased Polymer Materials, Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Huaping Wang
- Key Lab of Biobased Polymer Materials, Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Yilin Sun
- Key Lab of Biobased Polymer Materials, Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Yang Jiang
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Sha Fang
- Key Lab of Biobased Polymer Materials, Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Ze Kan
- Key Lab of Biobased Polymer Materials, Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Yingxi Lu
- College of Materials Science and Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Shenghou Liu
- Department of Orthopaedics, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Xianfeng Zhou
- Key Lab of Biobased Polymer Materials, Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Zhibo Li
- College of Chemical Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
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The effects of photobiomodulation using LED on the repair process of skin graft donor sites. Lasers Med Sci 2021; 37:1881-1890. [PMID: 34713365 DOI: 10.1007/s10103-021-03447-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
The benefits of photobiomodulation (PBM) applied to wounds are well-described in the literature; however, its effects in skin graft donor sites have been poorly studied. The aim of this study is to evaluate the effects of LED PBM on re-epithelialization and wound quality of the skin donor site and on pain during repair process. This is a case series study that part of the patients received standard treatment and the others received standard treatment combined with PBM. Data collection was performed at the Burn Unit at a Public Hospital, Brazil. The study had 21 participants and 25 donor sites, 13 in the control group (conventional treatment with Membracel® bandage) and 12 in the experimental group (Membracel® + LED). Irradiation parameters were 1.53 J/cm2, 2.55 mW/cm2, 660 nm, 600 s in the immediate postoperative period as well as on the 1st, 3rd, 5th, and 7th days postoperatively. Pain was measured using the visual analog scale. The Bates-Jensen scale was used to monitor the re-epithelialization process and measurements were performed of donor skin sites in the postoperative period. Quantitative variables were expressed as mean ± standard deviation or median and interquartile range [p25; p75]. The comparison of the distribution of these variables between groups was performed using the Mann-Whitney test. No differences between groups were found for re-epithelialization time, area or quality of the wound. Regarding pain, a significant reduction was found on the 5th postoperative day in the experimental group compared to the control group. PBM did not induce changes in the re-epithelialization period, wound area or wound quality scores of the Bates-Jensen Scale but did induce a reduction in pain compared to the group treated with Membracel® alone.
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García-Sánchez JM, Mirabet Lis V, Ruiz-Valls A, Pérez-Plaza A, Sepúlveda Sanchis P, Pérez-Del-Caz MD. Platelet rich plasma and plasma rich in growth factors for split-thickness skin graft donor site treatment in the burn patient setting: A randomized clinical trial. Burns 2021; 48:1662-1670. [PMID: 34952738 DOI: 10.1016/j.burns.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Management of donor site morbidity in the setting of split thickness skin graft (STSG) is of crucial importance with no superior wound dressing described to date and the growing need of decreasing epithelializing time. The purpose of the study was to compare the standard of care using a hydrocolloid dressing to platelet rich plasma (PRP) and plasma rich in growth factors (PRGF) in order to determine its therapeutic potential in this setting. METHODS A randomized clinical trial was conducted in which each patient served as its own control. PRGF was obtained by means of freeze-thaw out of the PRP from the subject of the study. Patients from the study had three donor sites and each donor site received either to PRP, PRGF or the standard of care, hydrocolloid. The main variable was time to epithelialization, and secondary variables subject to study were pain, quality of the scar, complications and cost. RESULTS 20 patients were recruited with a total number of 60 donor sites to study. On the 8th post-operative day 55% and 45% of the sites treated with PRP and PRGF, respectively, complete epithelialization was observed as compared to 20% of the sites treated with hydrocolloid, statistical significance was achieved between the latter two (p = 0.036). The areas treated with PRP and PRGF received inferior values on the visual analog scale on post-op day 5 and 8 compared to hydrocolloid. Values on wound healing metrics were lower in the PRP when compared to hydrocolloid. No adverse effects were recorded. CONCLUSION Donor site of STSG treated with PRP in the setting of the burn patient decreased time to epithelialization. In our study a better pain control and in scar quality was observed in both, the PRP and PRGF group.
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Affiliation(s)
| | - Vicente Mirabet Lis
- Center for Blood Transfusion and Tissue Bank of Valencian Community, Valencia, Spain
| | - Alejandro Ruiz-Valls
- Department of Plastic and Reconstructive Surgery and Burns, La Fe Hospital, Valencia, Spain.
| | - Aranzazu Pérez-Plaza
- Department of Plastic and Reconstructive Surgery and Burns, La Fe Hospital, Valencia, Spain
| | - Pilar Sepúlveda Sanchis
- Regenerative Medicine and Heart Transplantation Unit, Health Research Institute Hospital La Fe, Valencia, Spain
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Intralesional platelet-rich plasma injection promotes tongue regeneration following partial glossectomy in a murine model. Oral Oncol 2021; 120:105422. [PMID: 34218061 DOI: 10.1016/j.oraloncology.2021.105422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We examined the regenerative efficacy of the activated platelet-rich plasma (PRP) concentrate administered by local injection in an animal model mimicking partial glossectomy for tongue cancer. METHODS Four-week-old mice were randomized to four groups; (1) a treatment-naïve control group, (2) a PRP group, (3) a hemiglossectomy group, and (4) a hemiglossectomy + PRP group. The activated PRP concentrate was injected into the deep layer of resected surfaces of mouse tongues immediately after excision, and tongue widths and lengths were measured on postoperative days (POD) 5 and 12. Gross tongue morphologies and microscopic findings were investigated. Inflammation and fibrous tissue areas were also measured, and immunohistochemical analysis was performed for c-kit, neurofilament, and S-100. RESULTS The activated PRP concentrate reduced wound scar contracture, promoted wound healing, and reduced inflammation and wound fibrosis. On POD 12, histologic findings in the hemiglossectomy + PRP group were similar to those in the normal control group, and the intensity of stem cell factor receptor c-kit expression was also significantly greater in the PRP group than in the hemiglossectomy group on POD 12. Immunohistochemical staining revealed S100 and neurofilament expressions in the hemiglossectomy + PRP group were significantly more intense than in the hemiglossectomy group. CONCLUSION Intralesional activated PRP concentrate injection has potential use for tongue regeneration, wound healing, and neural regeneration with minimal scarring after partial glossectomy.
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Brewer CF, Smith A, Miranda BH. The use of platelet-rich products for skin graft donor site healing: a systematic review and meta-analysis. J Plast Surg Hand Surg 2021; 55:133-140. [PMID: 33190577 DOI: 10.1080/2000656x.2020.1846544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/29/2020] [Indexed: 01/13/2023]
Abstract
Split thickness skin grafting is a common reconstructive technique which carries unavoidable donor site morbidity. The aim of this systematic review and meta-analysis is to present the evidence for the use of platelet rich plasma as an adjunct to donor site wound healing. A comprehensive literature search was performed, according to PRISMA guidelines from inception to August 2020, for studies regarding platelet rich plasma and skin graft donor site healing. Animal studies, case series of less than three cases and studies reporting histological outcomes only were excluded. The literature search identified 114 articles. After applying the exclusion criteria, four randomised control trials and two case-control studies remained, incorporating a total of 218 wounds in 139 patients. Four out of six studies reported total healing times for donor site wounds. Pooled analysis showed a significant reduction in healing time when donor wounds were treated with PRP versus controls [MD 5.95, 95% CI 5.04-6.85, p < 0.001]. Of the five studies which reported pain at dressing change, four showed significantly reduced pain scores for the platelet rich plasma treated wounds versus control. There were no significant complications recorded in the treated wounds. The current evidence basis for platelet rich plasma in donor site healing is limited by heterogeneous methodology and reporting outcomes and low powered studies. Nevertheless, the preponderance of data supports its use for accelerating wound healing and reducing pain at dressing change. These preliminary findings need to be substantiated with higher powered randomised controlled trials with standardised PRP manufacture and reporting structures.
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Affiliation(s)
- Christopher F Brewer
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Alexander Smith
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Ben H Miranda
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
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Cole AM, Sclafani AP. Theory and Evidence for Platelet Therapy of the Aging Face. Facial Plast Surg 2021; 37:218-223. [PMID: 33634450 DOI: 10.1055/s-0041-1725107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Platelet preparations are autologous blood concentrates with supraphysiologic concentrations of platelets with or without leukocytes used in various clinical applications including regenerative medicine, wound healing, and facial rejuvenation. Their use harnesses the important role of platelets and their secretory products in immunoregulation, wound healing, angiogenesis, and tissue remodeling. The use of platelet preparations has been long documented in orthopaedic surgery, maxillofacial surgery, and other fields, but over the years research has increased in their application to facial plastic surgical techniques. Here we review the various formulations of platelet rich concentrates, their applications to facial skin rejuvenation, wound healing, scar reduction, and tissue fill as documented in the literature since 2018.
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Affiliation(s)
- Arron M Cole
- Otolaryngology Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Anthony P Sclafani
- Department of Otolaryngology, Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York.,Department of Facial Plastic Surgery, Center for Facial Plastic Surgery, Chappaqua, New York
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Asuku M, Yu TC, Yan Q, Böing E, Hahn H, Hovland S, Donelan MB. Split-thickness skin graft donor-site morbidity: A systematic literature review. Burns 2021; 47:1525-1546. [PMID: 33781633 DOI: 10.1016/j.burns.2021.02.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
The purpose of this systematic literature review is to critically evaluate split-thickness skin graft (STSG) donor-site morbidities. The search of peer-reviewed articles in three databases from January 2009 to July 2019 identified 4271 English-language publications reporting STSG donor-site clinical outcomes, complications, or quality of life. Of these studies, 77 met inclusion criteria for analysis. Mean time to donor-site epithelialization ranged from 4.7 to 35.0 days. Mean pain scores (0-10 scale) ranged from 1.24 to 6.38 on postoperative Day 3. Mean scar scores (0-13 scale) ranged from 0 to 10.9 at Year 1. One study reported 28% of patients had donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0 to 56%. Less frequently reported outcomes included pruritus, wound exudation, and esthetic dissatisfaction. Donor-site wounds underwent days of wound care and were frequently associated with pain and scarring. Widespread variations were noted in STSG donor-site outcomes likely due to inconsistencies in the definition of outcomes and utilization of various assessment tools. Understanding the true burden of donor sites may drive innovative treatments that would reduce the use of STSGs and address the associated morbidities.
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Affiliation(s)
- Malachy Asuku
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Tzy-Chyi Yu
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA.
| | - Qi Yan
- Oxford PharmaGenesis Inc., 4 Caufield Place, Suite 201, Newtown, PA, 18940, USA
| | - Elaine Böing
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Helen Hahn
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Sara Hovland
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Matthias B Donelan
- Shriners Hospital for Children-Boston, 51 Blossom Street, Suite 930, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02114, USA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Clinical Utility of Extracorporeal Shock Wave Therapy on Hypertrophic Scars of the Hand Caused by Burn Injury: A Prospective, Randomized, Double-Blinded Study. J Clin Med 2020; 9:jcm9051376. [PMID: 32392796 PMCID: PMC7290924 DOI: 10.3390/jcm9051376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/29/2023] Open
Abstract
Postburn hypertrophic scarring is a common complication in burn injuries to the hands, often associated with impaired hand function. We evaluated the effects of extracorporeal shock wave therapy (ESWT), compared to a sham stimulation therapy, on hypertrophic scars of the hand caused by burn injury and investigated its effects on hand function. This was a double-blinded, randomized, controlled trial of 48 patients with a burn to their dominant right hand. The parameters of ESWT were as follows: energy flux density, 0.05–0.30 mJ/mm2; frequency, 4 Hz; 1000 to 2000 impulses per treatment; four treatments, once a week for four weeks. The outcomes measured were as follows: a 10-point visual analogue scale pain score; Vancouver scar scale for scar vascularity, height, pliability and pigmentation; ultrasound measurement of scar thickness; Jebsen−Taylor hand function test; grip strength; Perdue pegboard test; and the Michigan hand outcomes questionnaire. The change in the score from baseline to post-treatment was compared between the two groups. ESWT improved the pain score (p = 0.001), scar thickness (p = 0.018), scar vascularity (p = 0.0015), and improved hand function (simulated card-turning, p = 0.02; picking up small objects, p = 0.004). The other measured outcomes were not different between the two groups. ESWT is effective in decreasing pain, suppressing hypertrophic scarring, and improving hand function.
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Vaheb M, Karrabi M, Khajeh M, Asadi A, Shahrestanaki E, Sahebkar M. Evaluation of the Effect of Platelet-Rich Fibrin on Wound Healing at Split-Thickness Skin Graft Donor Sites: A Randomized, Placebo-Controlled, Triple-Blind Study. INT J LOW EXTR WOUND 2020; 20:29-36. [DOI: 10.1177/1534734619900432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Split-thickness skin grafting (STSG) is widely used to heal wounds resulting from trauma, burns, and chronic wounds. This study aimed to determine the true effect of platelet-rich fibrin (PRF) on patients with burn wounds requiring STSG during treatment of donor wounds. This randomized, triple-blind clinical trial was conducted on patients who referred to the burn ward of Vasei Hospital of Sabzevar, Iran, from May 2017 to May 2018. The donor site was randomly divided into 2 groups: PRF and control (Vaseline petrolatum gauze) using Vaseline gauze. In the intervention group, the PRF gel was applied to the wound and covered with Vaseline gauze and wet dressing. Conversely, only Vaseline gauze and wet dressing were applied to the control group. Outcome evaluation was conducted using paired t test and Wilcoxon signed rank-sum test, as appropriate, on days 8 and 15. The mean age of the patients was 33.10 ± 2.60 years, and 51.50% were male. The mean wound healing time in the PRF and control groups was 11.80 ± 3.51 and 16.30 ± 4.32 days, respectively ( P < .001). The PRF group showed significantly higher wound healing rates than the control group at 8 and 15 days dressing ( P < .001 and P < .001, respectively). Moreover, the mean wound healing for all wound healing indices diagnosed by 2 specialists in PRF was higher than control group on days 8 and 15 ( P < .001). We found a statistically significant difference on days 8 and 15 regarding the mean pain levels between the 2 groups ( P < .001). The findings showed that PRF can significantly increase the time and rate of donor wound healing compared with conventional treatment and also reduce the severity of pain.
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Affiliation(s)
- Mojtaba Vaheb
- Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Mahtab Khajeh
- Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Alireza Asadi
- Sabzevar University of Medical Sciences, Sabzevar, Iran
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