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Retchkiman M, Ron O, Stuchiner B, Gronovich Y. A comparison of surgical scar treatment using various combinations of autologous fat, hyaluronic acid and resurfacing with the 1540 nm non-ablative Erbium laser - a prospective pilot study. J COSMET LASER THER 2024:1-6. [PMID: 39163996 DOI: 10.1080/14764172.2024.2390585] [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: 05/10/2022] [Revised: 01/10/2024] [Accepted: 08/06/2024] [Indexed: 08/22/2024]
Abstract
Scars can cause aesthetic or functional disturbance. Several interventions had been described to improve their appearance. We propose that the combination of some of those treatments can synergize their effects on the scar. We designed a prospective pilot study with ten patients using the patient as their own control to compare different interventions. In each patient, the scar was divided into four parts treated differently: 1. No treatment (control), 2. Fat grafting only, 3. Fat grafting and Hyaluronic Acid (HA), 4. Fat grafting, HA and with a non-fractional laser. Each part of the scar was evaluated by the Patient and Observer Scar Assessment Scale (POSAS). Treatment of the scar with the combination of the three modalities showed better results in the observer scale. In addition, a combination of fat injection, HA, and subsequent skin resurfacing with non-ablative laser showed better outcomes for all parameters on the Observer Scale except vascularity, while on the Patient Scale thickness, relief, pliability, surface area, and overall measurement were better. The combination of all three treatments tends to improve scarring results and appears to be safe and effective. However, further studies with larger samples are needed to explore the potential use of this combined treatment.
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Affiliation(s)
- Meir Retchkiman
- Department of Plastic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
- Department of Plastic Surgery, Soroka Medical Center, Be'er Sheva, Israel
| | - Ofir Ron
- Department of Plastic Surgery, Soroka Medical Center, Be'er Sheva, Israel
| | - Barak Stuchiner
- Department of Plastic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yoav Gronovich
- Department of Plastic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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2
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Almadori A, Butler PE. Scarring and Skin Fibrosis Reversal with Regenerative Surgery and Stem Cell Therapy. Cells 2024; 13:443. [PMID: 38474408 DOI: 10.3390/cells13050443] [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: 01/16/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Skin scarring and fibrosis affect millions of people worldwide, representing a serious clinical problem causing physical and psychological challenges for patients. Stem cell therapy and regenerative surgery represent a new area of treatment focused on promoting the body's natural ability to repair damaged tissue. Adipose-derived stem cells (ASCs) represent an optimal choice for practical regenerative medicine due to their abundance, autologous tissue origin, non-immunogenicity, and ease of access with minimal morbidity for patients. This review of the literature explores the current body of evidence around the use of ASCs-based regenerative strategies for the treatment of scarring and skin fibrosis, exploring the different surgical approaches and their application in multiple fibrotic skin conditions. Human, animal, and in vitro studies demonstrate that ASCs present potentialities in modifying scar tissue and fibrosis by suppressing extracellular matrix (ECM) synthesis and promoting the degradation of their constituents. Through softening skin fibrosis, function and overall quality of life may be considerably enhanced in different patient cohorts presenting with scar-related symptoms. The use of stem cell therapies for skin scar repair and regeneration represents a paradigm shift, offering potential alternative therapeutic avenues for fibrosis, a condition that currently lacks a cure.
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Affiliation(s)
- Aurora Almadori
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College of London, London NW3 2QG, UK
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London NW3 2QG, UK
- The Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital Campus, University College of London, London NW3 2QG, UK
| | - Peter Em Butler
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College of London, London NW3 2QG, UK
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London NW3 2QG, UK
- The Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital Campus, University College of London, London NW3 2QG, UK
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3
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Feng W, Yang L, Li J, Chen Y, Yao B. A bibliometric analysis of trends in the application of platelet-rich plasma in cosmetics research between 2001 and 2022. J Cosmet Dermatol 2024; 23:780-793. [PMID: 37966031 DOI: 10.1111/jocd.16062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Several studies have been conducted on using platelet-rich plasma (PRP) to treat cosmetic issues. Nonetheless, no bibliometric analyses of publications in this field exist. Bibliometrics is an effective tool for methodically assessing the current state of research on a particular topic. This study examines the literature published in this field since 2000 and depicts the resulting network. METHODS The Web of Science Core Collection was searched for any publications mentioning the use of PRP in cosmetic or aesthetic therapy published between 2001 and 2022. The author, region, institution, journal, cited journal, and keywords were extracted, and the bibliometric analysis was carried out using CiteSpace and R studio. RESULTS There were a total of 306 items retrieved. The first publication in this field appeared in 2001, and the number of articles published increased over the next 21 years. Saedi Nazanin is the author with the most publications. The most prolific nations and institutions were the United States and the Fourth Military Medical University, respectively. Similarly, most articles and citations were found in the Journal of Cosmetic Dermatology and Plastic and Reconstructive Surgery. After performing a cluster analysis on the keywords of published publications, we discovered that most of the published literature focused on using PRP in rejuvenation, mechanism, and combination with MSCs. These topics are still at the frontier of future research. CONCLUSION Since the first study in this field was published in 2001, PRP used in cosmetic clinics has been studied. Although early effects have been observed, numerous challenges remain, including a lack of higher-quality clinical studies and explanations of PRP's mechanism. The bibliometric analysis conducted for the purpose of this article provides a summary of academic hotspots and research frontiers, as well as insights and pointers for future productive research.
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Affiliation(s)
- Wei Feng
- Department of Plastic & Reconstructive Surgery, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lichang Yang
- Department of Breast Oncoplastic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jingyu Li
- Department of Plastic & Reconstructive Surgery, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yan Chen
- Department of Plastic & Reconstructive Surgery, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Bin Yao
- Department of Orthopedics, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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4
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Debuc B, Gendron N, Cras A, Rancic J, Philippe A, Cetrulo CL, Lellouch AG, Smadja DM. Improving Autologous Fat Grafting in Regenerative Surgery through Stem Cell-Assisted Lipotransfer. Stem Cell Rev Rep 2023; 19:1726-1754. [PMID: 37261667 DOI: 10.1007/s12015-023-10568-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
Autologous fat transplantation -i.e., lipofilling- has become a promising and popular technique in aesthetic and reconstructive surgery with several application such as breast reconstruction, facial and hand rejuvenation. However, the use of this technology is still limited due to an unpredictable and low graft survival rate (which ranges from 25%-80%). A systematic literature review was performed by thoroughly searching 12 terms using the PubMed database. The objective of this study is to present the current evidence for the efficacy of adjuvant regenerative strategies and cellular factors, which have been tested to improve fat graft retention. We present the main results (fat retention rate, histological analysis for pre-clinical studies and satisfaction/ complication for clinical studies) obtained from the studies of the three main fat grafting enrichment techniques: platelet-rich plasma (PRP), the stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs) and discuss the promising role of recent angiogenic cell enrichment that could induce early vascularization of fat graft. All in all, adding stem or progenitor cells to autologous fat transplantation might become a new concept in lipofilling. New preclinical models should be used to find mechanisms able to increase fat retention, assure safety and transfer these technologies to a good manufacturing practice (GMP) compliant facility, to manufacture an advanced therapy medicinal product (ATMP).
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Affiliation(s)
- Benjamin Debuc
- Department of Plastic Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France
| | - Audrey Cras
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Cell Therapy, Saint Louis Hospital, AP-HP, F-75010, Paris, France
| | - Jeanne Rancic
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
| | - Aurélien Philippe
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children-Boston, Boston, MA, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandre G Lellouch
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children-Boston, Boston, MA, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David M Smadja
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France.
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France.
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5
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Vingan NR, Wamsley CE, Panton JA, Mangalagiri D, Turer D, Akgul Y, Barillas J, Culver A, Kenkel JM. Investigating the Efficacy of Modified Lipoaspirate Grafting to Improve the Appearance of Atrophic Acne Scars: A Pilot Study. Aesthet Surg J 2023; 43:NP613-NP630. [PMID: 37051925 DOI: 10.1093/asj/sjad102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. Although lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis. OBJECTIVES This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars. METHODS Patients underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3 and 6 months posttreatment. Scars were assessed with standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed with patient and clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation. RESULTS Ten patients between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. Clinician GAIS and patient GAIS scores showed clinical improvement at both 3- and 6-month follow-up compared with baseline (P < .05). Blinded clinician GAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (P < .0001). The attenuation coefficient increased at 6-month follow-up, suggesting collagen remodeling and reorganization over the study period. Patients experienced anticipated posttreatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported. CONCLUSIONS Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring. LEVEL OF EVIDENCE: 4
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Troha K, Vozel D, Arko M, Bedina Zavec A, Dolinar D, Hočevar M, Jan Z, Kisovec M, Kocjančič B, Pađen L, Pajnič M, Penič S, Romolo A, Repar N, Spasovski V, Steiner N, Šuštar V, Iglič A, Drobne D, Kogej K, Battelino S, Kralj-Iglič V. Autologous Platelet and Extracellular Vesicle-Rich Plasma as Therapeutic Fluid: A Review. Int J Mol Sci 2023; 24:3420. [PMID: 36834843 PMCID: PMC9959846 DOI: 10.3390/ijms24043420] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
The preparation of autologous platelet and extracellular vesicle-rich plasma (PVRP) has been explored in many medical fields with the aim to benefit from its healing potential. In parallel, efforts are being invested to understand the function and dynamics of PVRP that is complex in its composition and interactions. Some clinical evidence reveals beneficial effects of PVRP, while some report that there were no effects. To optimize the preparation methods, functions and mechanisms of PVRP, its constituents should be better understood. With the intention to promote further studies of autologous therapeutic PVRP, we performed a review on some topics regarding PVRP composition, harvesting, assessment and preservation, and also on clinical experience following PVRP application in humans and animals. Besides the acknowledged actions of platelets, leukocytes and different molecules, we focus on extracellular vesicles that were found abundant in PVRP.
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Affiliation(s)
- Kaja Troha
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, SI-1000 Ljubljana, Slovenia
| | - Matevž Arko
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
| | - Apolonija Bedina Zavec
- Department of Molecular Biology and Nanobiotechnology, National Institute of Chemistry, SI-1000 Ljubjana, Slovenia
| | - Drago Dolinar
- Department of Orthopedic Surgery, University Medical Centre, Zaloška 9, SI-1000 Ljubljana, Slovenia
- MD-RI Institute for Materials Research in Medicine, Bohoričeva 5, SI-1000 Ljubljana, Slovenia
| | - Matej Hočevar
- Department of Physics and Chemistry of Materials, Institute of Metals and Technology, SI-1000 Ljubljana, Slovenia
| | - Zala Jan
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
| | - Matic Kisovec
- Department of Molecular Biology and Nanobiotechnology, National Institute of Chemistry, SI-1000 Ljubjana, Slovenia
| | - Boštjan Kocjančič
- Department of Orthopedic Surgery, University Medical Centre, Zaloška 9, SI-1000 Ljubljana, Slovenia
| | - Ljubiša Pađen
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
| | - Manca Pajnič
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
| | - Samo Penič
- University of Ljubljana, Laboratory of Physics, Faculty of Electrical Engineering, SI-1000 Ljubljana, Slovenia
| | - Anna Romolo
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
- University of Ljubljana, Laboratory of Physics, Faculty of Electrical Engineering, SI-1000 Ljubljana, Slovenia
| | - Neža Repar
- University of Ljubljana, Research Group for Nanobiology and Nanotoxicology, Biotechnical Faculty, SI-1000 Ljubljana, Slovenia
| | - Vesna Spasovski
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11000 Belgrade, Serbia
| | - Nejc Steiner
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Vid Šuštar
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
| | - Aleš Iglič
- University of Ljubljana, Laboratory of Physics, Faculty of Electrical Engineering, SI-1000 Ljubljana, Slovenia
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Medicine, SI-1000 Ljubljana, Slovenia
| | - Damjana Drobne
- University of Ljubljana, Research Group for Nanobiology and Nanotoxicology, Biotechnical Faculty, SI-1000 Ljubljana, Slovenia
| | - Ksenija Kogej
- University of Ljubljana, Chair of Physical Chemistry, Faculty of Chemistry and Chemical Technology, SI-1000 Ljubljana, Slovenia
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, SI-1000 Ljubljana, Slovenia
| | - Veronika Kralj-Iglič
- University of Ljubljana, Laboratory of Clinical Biophysics, Faculty of Health Sciences, SI-1000 Ljubljana, Slovenia
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Schipper JAM, Vriend L, Tuin AJ, Dijkstra PU, Schepers RH, van der Lei B, Jansma J, Harmsen MC. Supplementation of Facial Fat Grafting to Increase Volume Retention: A Systematic Review. Aesthet Surg J 2022; 42:NP711-NP727. [PMID: 35576617 PMCID: PMC9750673 DOI: 10.1093/asj/sjac122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND For decades, facial fat grafting has been used in clinical practice for volume restoration. The main challenge of this technique is variable volume retention. The addition of supplements to augment fat grafts and increase volume retention has been reported in recent years. OBJECTIVES The aim of this systematic review was to investigate which supplements increase volume retention in facial fat grafting as assessed by volumetric outcomes and patient satisfaction. METHODS Embase, Medline, Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to November 30, 2020. Only studies assessing volume after facial fat grafting with supplementation in human subjects were included. Outcomes of interest were volume or patient satisfaction. The quality of the studies was assessed with the Effective Public Health Practice Project tool. RESULTS After duplicates were removed 3724 studies were screened by title and abstract. After reading 95 full-text articles, 27 studies were eligible and included for comparison. Supplementation comprised of platelet-rich plasma, platelet-rich fibrin, adipose tissue-derived stromal cells or bone marrow-derived stromal cells, cellular or tissue stromal vascular fraction, or nanofat. In 13 out of 22 studies the supplemented group showed improved volumetric retention and 5 out of 16 studies showed greater satisfaction. The scientific quality of the studies was rated as weak for 20 of 27 studies, moderate for 6 of 27 studies, and strong for 1 study. CONCLUSIONS It remains unclear if additives contribute to facial fat graft retention and there is a need to standardize methodology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jan Aart M Schipper
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Linda Vriend
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Aartje J Tuin
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rutger H Schepers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Berend van der Lei
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Johan Jansma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin C Harmsen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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8
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Aljefri YE, Ghaddaf AA, Alahmadi RA, Alkhamisi TA, Alkhunani TA, Samarkandy SJ, Alamri AM. Ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma in the treatment of atrophic acne scars: A systematic review and meta-analysis. Dermatol Ther 2022; 35:e15888. [PMID: 36183145 DOI: 10.1111/dth.15888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR = 2.56, 95% CI 1.37-4.78 and OR = 3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.
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Affiliation(s)
- Yara E Aljefri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Rana A Alahmadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Taif A Alkhamisi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Tala A Alkhunani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Sahal J Samarkandy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Awadh M Alamri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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9
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Zhang X, Li G. Effectiveness of fat grafting in scar reduction: A systematic review and meta-analysis. J Cosmet Dermatol 2022; 21:5804-5810. [PMID: 35531797 DOI: 10.1111/jocd.15067] [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: 12/14/2021] [Revised: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Scar brings great physical and mental pain to patients. Fat grafting may be a new and simple way to treat scar. This review aimed to systematically evaluate the correlation between fat grafting and scar reduction. METHODS The author searched Chinese and English literature databases such as CNKI, Wanfang Data, Cqvip, Pubmed, Web of Science, Embase, CBM, etc. for articles published in the period from 2011 to 2021 about the randomized controlled trials (RCTs) to assess the effect of fat grating on scar reduction, and then performed meta-analysis with Review Manager 5.4. RESULTS A total of nine articles were included in the assessment of the effect of fat grafting on scar reduction, with meta-analysis suggesting statistical significance (OR = 5.63, 95% CI: 3.01-10.53, p < 0.01). There was statistical significance in the difference observed between the simple fat grating group (p = 0.004) and the group of existing therapies combined with fat grafting (p < 0.0001). CONCLUSION Fat grafting may be a good method for scar treatment, especially when it's combined with other therapies. Still, due to the limitations of included RCTs, more large-scale high-quality RCTs must be carried out before solid conclusions can be drawn.
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Affiliation(s)
| | - Guangxue Li
- Peking University People's Hospital, Beijing, China
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10
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Gronovich Y, Maisel Lotan A. Treatment of scars with autologous fat grafting and 1540 nm non-ablative erbium laser. J COSMET LASER THER 2022; 24:80-83. [PMID: 35318875 DOI: 10.1080/14764172.2022.2055078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Scars may be devastating for patients. Fat grafting and non-ablative lasers are available options for improvement. The former reshapes and improves scar quality by adding volume and regenerative adipose-derived stem cells, whereas the latter facilitates synthesis and deposition of new dermal collagen. The combination may be synergic, leading to better cosmetic outcome.This was a prospective study of 16 consecutive patients treated with autologous fat grafting and non-ablative 1540-nm erbium laser for facial scars between January 2015 and December 2015. Treatment protocol included fat injection followed by five treatments with 1540-nm erbium laser (ICONTM Cynosure; Westford, MA, USA) a month later. We evaluated patients before, after treatments, and 6 months after the final treatment.Sixteen patients participated in our study. Mean patient age was 42 years (range 16-59 years). Scars were either traumatic (73%) or acne induced (27%). Traumatic scars were mainly new scars, with the majority of patients were treated within 30 days of injury. There were no reported complications. Scars improved in both texture and appearance and patient satisfaction was high in all cases.Treatment of scars with autologous fat grafting and fractional non-ablative 1540-nm erbium laser is safe and efficient and results in improved scar appearance and texture.
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Affiliation(s)
- Yoav Gronovich
- Hebrew University, Jerusalem, Israel.,Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Maisel Lotan
- Hebrew University, Jerusalem, Israel.,Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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11
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The Opportunities and Challenges regarding Induced Platelets from Human Pluripotent Stem Cells. Stem Cells Int 2021; 2021:5588165. [PMID: 34054969 PMCID: PMC8112939 DOI: 10.1155/2021/5588165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022] Open
Abstract
As a standard clinical treatment, platelet transfusion has been employed to prevent hemorrhage in patients with thrombocytopenia or platelet dysfunctions. Platelets also show therapeutic potential for aiding liver regeneration and bone healing and regeneration and for treating dermatological conditions. However, the supply of platelets rarely meets the rising clinical demand. Other issues, including short shelf life, strict storage temperature, and allogeneic immunity caused by frequent platelet transfusions, have become serious challenges that require the development of high-yielding alternative sources of platelets. Human pluripotent stem cells (hPSCs) are an unlimited substitution source for regenerative medicine, and patient-derived iPSCs can provide novel research models to explore the pathogenesis of some diseases. Many studies have focused on establishing and modifying protocols for generating functional induced platelets (iPlatelets) from hPSCs. To reach high efficiency production and eliminate the exogenous antigens, media supplements and matrix have been optimized. In addition, the introduction of some critical transgenes, such as c-MYC, BMI1, and BCL-XL, can also significantly increase hPSC-derived platelet production; however, this may pose some safety concerns. Furthermore, many novel culture systems have been developed to scale up the production of iPlatelets, including 2D flow systems, 3D rotary systems, and vertical reciprocal motion liquid culture bioreactors. The development of new gene-editing techniques, such as CRISPR/Cas9, can be used to solve allogeneic immunity of platelet transfusions by knocking out the expression of B2M. Additionally, the functions of iPlatelets were also evaluated from multiple aspects, including but not limited to morphology, structure, cytoskeletal organization, granule content, DNA content, and gene expression. Although the production and functions of iPlatelets are close to meeting clinical application requirements in both quantity and quality, there is still a long way to go for their large-scale production and clinical application. Here, we summarize the diverse methods of platelet production and update the progresses of iPlatelets. Furthermore, we highlight recent advances in our understanding of key transcription factors or molecules that determine the platelet differentiation direction.
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12
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Kaushik A, Kumaran MS. Platelet-Rich Plasma: The Journey so Far ! Indian Dermatol Online J 2020; 11:685-692. [PMID: 33235832 PMCID: PMC7678541 DOI: 10.4103/idoj.idoj_369_19] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/24/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022] Open
Abstract
Platelet-rich plasma (PRP) is an autologous blood product, obtained after blood centrifugation. PRP is rich in growth factors which promote tissue-healing, alter angiogenesis, and possess versatile immunomodulatory effects, in the relative absence of any significant demonstrable adverse effects. Consequently, PRP has found application in multiple specialities in recent years, including dermatology. A literature search was performed on PubMed, Medline database, and Google Scholar, using keywords like platelet-rich plasma (PRP), platelet-concentrated plasma, platelet-rich growth factors, autologous platelet concentrate. Relevant studies were selected, and data was analyzed following extraction. Studies show that PRP has not only been used as an adjunctive modality but has been employed as a stand-alone therapy as well. Multiple authors have reported PRP to be efficacious in disparate dermatological conditions, like alopecia, skin rejuvenation, healing of refractory cutaneous ulcers, and even acne scar management. The strongest evidence so far has been demonstrated in androgenetic alopecia and facial skin rejuvenation. However, routine use in dermatological conditions is hampered by the relative paucity of high-quality evidence and large randomized studies. Furthermore, PRP composition and preparation methods are not yet standardized and even the treatment regimens proposed too vary widely. The present review provides a bird's eye view of the evidence available so far regarding the use of PRP in dermatology. The review focusses more on recent prospective studies, including randomized trials and tries to summarize the evidence in a brief, but comprehensive manner.
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Affiliation(s)
- Akanksha Kaushik
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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13
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Nassar SO, Eltatawy RAR, Hassan GFR. Safety and efficacy of platelet‐rich plasma vs carboxytherapy in the treatment of atrophic scars: A comparative clinical and histopathological study. Dermatol Ther 2020; 33:e13942. [DOI: 10.1111/dth.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Samia O. Nassar
- Faculty of Medicine, Department of Dermatology and Venereology Tanta University Tanta Egypt
| | - Rania A. R. Eltatawy
- Faculty of Medicine, Department of Dermatology and Venereology Tanta University Tanta Egypt
| | - Ghada F. R. Hassan
- Faculty of Medicine, Department of Dermatology and Venereology Tanta University Tanta Egypt
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14
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Abstract
BACKGROUND Autologous fat grafting is a dynamic modality used in plastic surgery as an adjunct to improve functional and aesthetic form. However, current practices in fat grafting for soft-tissue augmentation are plagued by tremendous variability in long-term graft retention, resulting in suboptimal outcomes and repetitive procedures. This systematic review identifies and critically appraises the evidence for various enrichment strategies that can be used to augment and improve the viability of fat grafts. METHODS A comprehensive literature search of the Medline and PubMed databases was conducted for animal and human studies published through October of 2017 with multiple search terms related to adipose graft enrichment agents encompassing growth factors, platelet-rich plasma, adipose-derived and bone marrow stem cells, gene therapy, tissue engineering, and other strategies. Data on level of evidence, techniques, complications, and outcomes were collected. RESULTS A total of 1382 articles were identified, of which 147 met inclusion criteria. The majority of enrichment strategies demonstrated positive benefit for fat graft survival, particularly with growth factors and adipose-derived stem cell enrichment. Platelet-rich plasma and adipose-derived stem cells had the strongest evidence to support efficacy in human studies and may demonstrate a dose-dependent effect. CONCLUSIONS Improved understanding of enrichment strategies contributing to fat graft survival can help to optimize safety and outcomes. Controlled clinical studies are lacking, and future studies should examine factors influencing graft survival through controlled clinical trials in order to establish safety and to obtain consistent outcomes.
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15
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Du R, Lei T. Effects of autologous platelet-rich plasma injections on facial skin rejuvenation. Exp Ther Med 2020; 19:3024-3030. [PMID: 32256789 PMCID: PMC7086200 DOI: 10.3892/etm.2020.8531] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022] Open
Abstract
Autologous serum platelet-rich plasma (PRP) has been used to rejuvenate wrinkled and aged skin for years; however, the molecular mechanism for the positive effects of PRP on the skin remains unclear. The present study aimed to clarify the potential molecular mechanisms for the role of PRP in wrinkled and aged skin rejuvenation, and provide evidence for future clinical applications. A total of 30 healthy females were recruited for PRP treatment and signed informed consent was obtained. A total of 3 autologous PRP injections were administered to each patient with 15-day intervals between injections. The effects of PRP injections were evaluated using the VISIA® Complexion Analysis System and skin computed tomography. A human organotypic skin model was established and treated with PBS or PRP before ultraviolet (UV)-B light (10 mJ/cm2) irradiation. The distribution of the epidermal structure and dermal fibers were analyzed by hematoxylin and eosin and Masson's trichome staining. Expression of matrix metalloproteinase-1 (MMP-1), tyrosinase, fibrillin and tropoelastin was detected by reverse transcription-quantitative PCR, western blotting and immunofluorescence. The present results showed that PRP treatment improved skin quality in the participants. In addition, the VISIA® results showed that wrinkles, texture and pores were decreased in the PRP groups compared with the PBS treatment. The in vitro study demonstrated that PRP treatment ameliorated photoaging by inhibiting UV-B-induced MMP-1 and tyrosinase upregulation, and by inducing fibrillin and tropoelastin expression that was downregulated by UV-B. Collectively, it was demonstrated that PRP treatment ameliorated skin photoaging through regulation of MMP-1, tyrosinase, fibrillin and tropoelastin expression.
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Affiliation(s)
- Rina Du
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China.,Department of Dermatology, Inner Mongolia International Mongolian Hospital, Hohhot, Inner Mongolia 010010, P.R. China
| | - Tiechi Lei
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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16
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Hsieh TS, Chiu WK, Yang TF, Wang HJ, Chen C. A Meta-analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars. Aesthetic Plast Surg 2019; 43:1615-1623. [PMID: 31506783 DOI: 10.1007/s00266-019-01471-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A number of studies have investigated the role of platelet-rich plasma (PRP) as an assisted therapy for atrophic acne scars. However, the results are diverse, and no up-to-date meta-analysis was found that exclusively examined atrophic acne scar treatment. OBJECTIVES To perform a meta-analysis to assess improvements in the side effects of PRP and the effect of assisted therapy for atrophic acne scars. METHODS This study followed PRISMA guidelines. A comprehensive search of the literature was carried out in September 2018 using the electronic databases of PubMed, EMBASE, MEDLINE, and the Cochrane Library. RESULTS Seven articles were included in this review. All of the studies published utilized PRP as additive therapy. The major therapies included fractional carbon laser therapy and microneedling. Five studies (249 participants) reported four degrees of improvement on an improvement scale (degrees 3 and 4 were considered improvement in this analysis). Four studies (200 participants) reported mean improvement scores. A significantly higher degree of improvement was shown in the PRP group compared to the control group (OR = 8.19; 95% CI 4.32-15.52; p < 0.00001), as well as better mean improvement score (WMD = 23.73; 95% CI 18.60-28.87; p < 0.00001). Substantial heterogeneity was seen in the degree of improvement (I2 = 54% p = 0.07) and the mean improvement score (I2 = 75%; p = 0.008). There were overall fewer monitored side effects, including erythema and edema (in days), in the PRP groups; however, no significance was found. CONCLUSIONS This review shows that PRP is a useful assisted therapy for atrophic acne scars, which can achieve better improvement. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Tyng-Shiuan Hsieh
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan, ROC
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan, ROC
- Graduate Institute of Medical Informatics and Cardiology, Taipei Medical University and Hospital, Taipei, Taiwan, ROC
| | - Hsian-Jenn Wang
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan, ROC.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan, ROC.
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan District, Taipei City, 11696, Taiwan, ROC.
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17
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García C, Pino A, Jimenez N, Truchuelo M, Jaén P, Anitua E. In vitro characterization and clinical use of platelet-rich plasma-derived Endoret-Gel as an autologous treatment for atrophic scars. J Cosmet Dermatol 2019; 19:1607-1613. [PMID: 31709744 DOI: 10.1111/jocd.13212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/10/2019] [Accepted: 10/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Normal healing process becomes severely dysregulated in pathophysiological conditions such as inflammation, infection or underlaying diseases. These scenarios hamper the standard healing pattern and dermal fibrotic tissue develops. OBJECTIVE In the present study a novel three-dimensional formulation (Endoret-Gel) based on plasma rich in growth factors technology (Endoret-PRGF) has been assessed for atrophic scar management. MATERIALS AND METHODS Microstructure analysis, growth factor content, and projection capacity of both formulations (Endoret-Gel and Endoret-PRGF) was assessed. Additionally, a clinical evaluation of Endoret-Gel treatment was also performed in a case of an extense atrophic scar. RESULTS Endoret-Gel presented high molecular weight plasmatic proteins that formed solid thermal aggregates enclosed by a stable fibrin network. This formulation has a higher cutaneous projection capacity compared with Endoret-PRGF. Both formulations presented a high load of bioactive proteins such as EGF, PDGF-AB, and IGF-I being higher in liquid Endoret-PRGF. Clinical results evidenced that infiltrations of Endoret-Gel derived in an early volumetric disposal that was maintained for several months. The treatment provided and immediate soft tissue augmentation and scar amelioration effect that was translated into a noticeable clinical improvement of the injury. No side effects or adverse events were reported during ten-month follow-up period. CONCLUSION These preliminary findings suggest that Endoret-Gel may act not only as a temporary volumizer but also as soft tissue stimulator that might be used as a monotherapy for scar management.
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Affiliation(s)
| | - Ander Pino
- BTI Biotechnology Institute, Vitoria, Spain
| | - Natalia Jimenez
- Grupo de Dermatología Pedro Jaén, Madrid, Spain.,University Hospital Ramon y Cajal, Madrid, Spain
| | - MªTeresa Truchuelo
- Grupo de Dermatología Pedro Jaén, Madrid, Spain.,Vithas Hospital Nuestra Señora de América, Madrid, Spain
| | - Pedro Jaén
- Grupo de Dermatología Pedro Jaén, Madrid, Spain.,University Hospital Ramon y Cajal, Madrid, Spain
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18
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Wang C, Xu M, Guo W, Wang Y, Zhao S, Zhong L. Clinical efficacy and safety of platelet-rich plasma in arthroscopic full-thickness rotator cuff repair: A meta-analysis. PLoS One 2019; 14:e0220392. [PMID: 31356630 PMCID: PMC6663026 DOI: 10.1371/journal.pone.0220392] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/14/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Arthroscopic repair of rotator cuff tears, although commonly performed, carries the risk of retears. Therefore, bioremediation techniques such as platelet-rich plasma injections have been used as adjuvant therapies. The clinical efficacy of platelet-rich plasma in the arthroscopic repair of full-thickness rotator cuff injury is controversial. We performed a meta-analysis to evaluate the clinical effectiveness and safety of platelet-rich plasma and provide evidence-based medical recommendations for selecting the proper clinical treatment plan for full-thickness rotator cuff injuries. METHODS A search for the terms "platelet-rich plasma" and "rotator cuff" was performed in the PubMed, EMBASE, and Cochrane Library databases using a computer. After conducting quality evaluations and data extraction, RevMan 5.3 software was used to combine the effect sizes, and the GRADEpro Guideline Development Tool was used to rate the level of evidence from aspects of functional score, pain score and retear rate. RESULTS Eight randomized controlled trials involving 566 patients were included. The long-term retear rate(RR = 0.96, 95% CI [0.52, 1.78], P = .89), Constant score(RR = 0.96, 95% CI [0.52, 1.78], P = .89), and Visual Analog Scale score for pain (SMD = -0.28, 95% CI [-0.60, 0.04], P = .08), as well as both the long-term and short-term Disabilities of the Arm, Shoulder, and Hand scores(SMD = -0.13, 95% CI [-0.44, 0.18], P = .41;SMD = -0.02, 95% CI [-0.40, 0.36], P = .93), were not significantly different between the platelet-rich plasma and control groups. However, the short-term retear rate(RR = 0.29, 95% CI [0.13, 0.65], P = .003) and Visual Analog Scale score (SMD = -0.41, 95% CI [-0.62, -0.19], P = .0002) were significantly lower, while the short-term Constant score(SMD = 0.37, 95% CI [0.19, 0.55], P < .0001) and short-term and long-term University of California at Los Angeles activity scores (SMD = 0.38, 95% CI [0.16, 0.60], P = .0008;SMD = 0.85, 95% CI [0.48, 1.22], P < .00001) were significantly higher, in the platelet-rich plasma group than in the control group. CONCLUSION Platelet-rich plasma injection can effectively improve the short-term outcomes following arthroscopic repair of full-thickness rotator cuff tears, thus reducing the rate of retears, alleviating pain, and improving patients' shoulder function. Specifically, the clinical outcomes are better with the use of platelet-rich plasma in single-row fixation than in other fixation techniques. Therefore, platelet-rich plasma injection can be recommended as an adjuvant therapy in single-row repair for improved short-term results.
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Affiliation(s)
- Chang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- College of Mathematics, Jilin University, Changchun, China
| | - Meng Xu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Wenlai Guo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yaodong Wang
- School of Science,China University of Mining & Technology, Beijing, China
| | - Shishun Zhao
- College of Mathematics, Jilin University, Changchun, China
| | - Lei Zhong
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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19
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Nicoletti G, Saler M, Villani L, Rumolo A, Tresoldi MM, Faga A. Platelet Rich Plasma Enhancement of Skin Regeneration in an ex-vivo Human Experimental Model. Front Bioeng Biotechnol 2019; 7:2. [PMID: 30701173 PMCID: PMC6343075 DOI: 10.3389/fbioe.2019.00002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/03/2019] [Indexed: 02/04/2023] Open
Abstract
This study reports on the development of an original, ex-vivo wounded skin culture protocol using autologous Platelet Rich Plasma (PRP) and enriched Dulbecco's Modified Eagle's Medium (DMEM). Human skin samples obtained from specimens harvested during reduction mammoplasty procedures, were injured in their central portion—to create a standard wound—and cultured under three different conditions: – enriched DMEM with saline solution in the central wound (control) – enriched DMEM with the same medium in the central wound – enriched DMEM plus 2.5% autologous PRP, with the same PRP added medium in the central wound. Morphological analysis was carried out at 0 h (T0) and on days 1, 3, 5 and 10 (T1-T3-T5-T10) using Hematoxylin and Eosin; Masson's trichrome staining; Weigert staining and Ki-67 staining to identify the skin histological features in the different experimental conditions. The combination of DMEM and PRP allowed a favorable modulation of the epithelial cells and fibroblasts proliferation, and a relevant anti-inflammatory action. PRP also demonstrated an inhibitory effect on both the collagen and elastic fibers' de-structuration and a favorable modulation of the re-organization of these fibers. The step by step histological and immune-histo-chemical regenerative effects of PRP on human skin wound repair and regeneration process was observed over a period of 10 days.
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Affiliation(s)
- Giovanni Nicoletti
- Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Pavia, Italy.,Plastic and Reconstructive Surgery Unit, Department of Surgery, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Marco Saler
- Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Villani
- Pathological Anatomy and Histology Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Agnese Rumolo
- Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Mario Tresoldi
- Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Plastic and Reconstructive Surgery Unit, Department of Surgery, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Angela Faga
- Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Pavia, Italy.,Plastic and Reconstructive Surgery Unit, Department of Surgery, Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
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20
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Alser OH, Goutos I. The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review. Scars Burn Heal 2018. [PMID: 30479843 DOI: 10.1177/2059513118808773]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Autologous platelet-based concentrates represent increasingly popular adjuncts to a variety of medical, surgical and aesthetic interventions. Their beneficial potential rests on the ability to deliver a high concentration of growth factors to the target tissues. There are currently no reports in the literature appraising the evidence behind the use of platelet-rich plasma (PRP) in scar management. Methods A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to the Joanna Briggs Institute Levels of evidence. The results are presented in descending order of evidence separately for atrophic, keloid, surgical and traumatic scars. Discussion On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including oedema and erythema. Regarding surgical scars, the current data suggest that PRP may improve wound healing and early scar quality; furthermore, incorporation of PRP in fat-grafting procedures undertaken in conjunction with non-ablative, fractional laser can contribute to better wound healing as well as a significant improvement in texture, colour and contour in traumatic scar resurfacing. There are no high level studies at present to support the incorporation of autologous platelet-based concentrates in the management of keloid scars. Conclusion PRP is a promising adjunct in scar management practice. Further research with long-term follow-up is warranted to delineate the value of this modality in different subtypes of scars.
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Affiliation(s)
- Osaid H Alser
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
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21
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Sayadi LR, Obagi Z, Banyard DA, Ziegler ME, Prussak J, Tomlinson L, Evans GRD, Widgerow AD. Platelet-Rich Plasma, Adipose Tissue, and Scar Modulation. Aesthet Surg J 2018; 38:1351-1362. [PMID: 29617719 DOI: 10.1093/asj/sjy083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Level of Evidence: 4.
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Affiliation(s)
- Lohrasb R Sayadi
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Zaidal Obagi
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Derek A Banyard
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Mary E Ziegler
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Jordyne Prussak
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Luke Tomlinson
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Gregory R D Evans
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Alan D Widgerow
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
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22
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Correction of cicatricial ectropion using non-ablative fractional laser resurfacing. Lasers Med Sci 2018; 34:79-84. [PMID: 30056585 DOI: 10.1007/s10103-018-2601-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
Lower eyelid malposition is the most frequent and severe complication after blepharoplasty and ectropion is observed in 1% of patients after surgery. This article describes a non-surgical method to treat lower eyelid cicatricial ectropion using a non-ablative laser as an alternative to surgery. Twelve patients with unilateral or bilateral lower lid cicatricial ectropion, following surgery or trauma, underwent laser therapy from 2012 to 2016. Laser therapy was performed with a fractional non-ablative laser emitting at a wavelength of 1540 nm. Ten patients had a full correction of their ectropion and two patients had a partial recovery after laser therapy at 6-month follow-up visit. No serious adverse events were reported. Non-ablative fractional laser resurfacing can successfully treat cicatricial ectropion by remodeling the periocular scar tissue and improving the scar texture, and as such may be considered as a valuable alternative to surgery in selected patients.
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23
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Zhang M, Park G, Zhou B, Luo D. Applications and efficacy of platelet-rich plasma in dermatology: A clinical review. J Cosmet Dermatol 2018; 17:660-665. [PMID: 30047234 DOI: 10.1111/jocd.12673] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Meijie Zhang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Gajin Park
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Bingrong Zhou
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Dan Luo
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
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Smith OJ, Kanapathy M, Khajuria A, Prokopenko M, Hachach-Haram N, Mann H, Mosahebi A. Systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing. Int Wound J 2018; 15:519-526. [PMID: 29745047 DOI: 10.1111/iwj.12892] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/31/2017] [Indexed: 12/17/2022] Open
Abstract
Adipose-derived stem cells found in fat grafts may have significant healing properties. When fat is combined with autologous platelet-rich plasma (PRP), there may be enhanced healing effects due to the pro-angiogenic and anti-inflammatory effects of PRP. This study aimed to evaluate the current evidence on fat grafting in combination with PRP for wound healing to establish the efficacy of this technique. A comprehensive search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (to March 2017) was conducted to identify studies on fat grafting and PRP for wound healing. Case series of less than 3 cases and studies only describing harvest technique were excluded. The database identified 571 articles, of which 3 articles that used a combination of fat and PRP for wound healing (1 RCT and 2 case series) were included in this review. A total of 69 wounds in 64 patients were treated with an average wound size of 36.32cm2 . Of these, 67% of wounds achieved complete healing. When reported, the mean time to healing was 7.5 weeks for those who underwent a single treatment. There were no significant complications in any patients. The combination of fat grafting and PRP may achieve adequate wound healing with relatively quick wound healing time compared with standard wound management options. However, evidence is extremely limited, and further studies are required to evaluate its efficacy for wound healing.
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Affiliation(s)
- Oliver J Smith
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Muholan Kanapathy
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Ankur Khajuria
- Academic Surgery Foundation Programme, St Mary's Hospital, Imperial College London, London, UK
| | - Max Prokopenko
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Nadine Hachach-Haram
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Haroon Mann
- Department of Trauma and Orthopaedics, Royal Free Hospital, London, UK
| | - Ash Mosahebi
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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Alser OH, Goutos I. The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review. Scars Burn Heal 2018; 4:2059513118808773. [PMID: 30479843 PMCID: PMC6243404 DOI: 10.1177/2059513118808773] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Autologous platelet-based concentrates represent increasingly popular adjuncts to a variety of medical, surgical and aesthetic interventions. Their beneficial potential rests on the ability to deliver a high concentration of growth factors to the target tissues. There are currently no reports in the literature appraising the evidence behind the use of platelet-rich plasma (PRP) in scar management. METHODS A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to the Joanna Briggs Institute Levels of evidence. The results are presented in descending order of evidence separately for atrophic, keloid, surgical and traumatic scars. DISCUSSION On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including oedema and erythema. Regarding surgical scars, the current data suggest that PRP may improve wound healing and early scar quality; furthermore, incorporation of PRP in fat-grafting procedures undertaken in conjunction with non-ablative, fractional laser can contribute to better wound healing as well as a significant improvement in texture, colour and contour in traumatic scar resurfacing. There are no high level studies at present to support the incorporation of autologous platelet-based concentrates in the management of keloid scars. CONCLUSION PRP is a promising adjunct in scar management practice. Further research with long-term follow-up is warranted to delineate the value of this modality in different subtypes of scars.
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Affiliation(s)
- Osaid H Alser
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
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Bellini E, Grieco MP, Raposio E. The science behind autologous fat grafting. Ann Med Surg (Lond) 2017; 24:65-73. [PMID: 29188051 PMCID: PMC5694962 DOI: 10.1016/j.amsu.2017.11.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 11/01/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Adipose grafting has undergone significant changes over time. Many different techniques have been followed by trying to improve the quality of the lipoaspirate and the survival of the fat graft after implantation. MATERIAL AND METHODS The purpose of this review is to analyse the historical evolution of the surgical harvesting and implant technique, describing the changes that have brought significant improvements, revolutionizing the aesthetic and functional results obtainable. RESULTS A standard fat grafting technique is commonly performed in three stages: harvesting of adipose tissue from a suitable donor site; processing of the lipoaspirate to eliminate cellular debris, acellular oil and excess of infiltrated solution, reinjection of the purified adipose tissue. The most widely used surgical technique was described by Coleman. He modified and corrected the methods and results of his predecessors and proposed an atraumatic protocol for the treatment of adipose tissue.He reported that the key to successful fat grafting lies in the technique. In addition, he noticed that adipose tissue was not only a good filler, but improved the quality of the skin. In fact, fat grafts demonstrated to have not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. CONCLUSION Adipose tissue, actually, is the closest to the ideal filler because it is readily available; easily obtainable, with low donor-site morbidity; repeatable; inexpensive; versatile; and biocompatible. There is an abundance of literature supporting the efficacy of fat grafting in both aesthetic and reconstructive cases. Recent studies have shown the utility of adipose-derived stem cells in the improvement of wound healing, describing their ability to regenerate soft tissues and their remodelling capacity provided by their unique cytokine and growth factor profiles.Despite ongoing concerns about survival and longevity of fat grafts after implantation and unpredictability of long-term outcome, fat has been successfully used as a filler in many differ clinic situation.
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Affiliation(s)
- Elisa Bellini
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele P. Grieco
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Luck J, Smith OJ, Mosahebi A. A Systematic Review of Autologous Platelet-Rich Plasma and Fat Graft Preparation Methods. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1596. [PMID: 29632775 PMCID: PMC5889438 DOI: 10.1097/gox.0000000000001596] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The addition of platelet-rich plasma (PRP) to adipose tissue may improve fat graft survival, although graft retention rates vary markedly between studies. To what extent this outcome heterogeneity reflects differing methodological factors remains unknown. This systematic review aims to synthesize and critically review methodological approaches to autologous PRP and fat cotransplantation in both human and animal studies. METHODS In accordance with PRISMA guidelines, Ovid MEDLINE, Scopus, and Cochrane Library databases were searched from inception to April 2017. Data were extracted from all in vivo studies involving autologous PRP and fat cotransplantation. A secondary aim was to assess reporting of technical detail; authors were not contacted to provide missing data. RESULTS From 335 articles, 23 studies were included in the qualitative synthesis. Some 21 were performed in humans and 2 in rabbits. Six studies were randomized control trials; the remainder reported on observational data. Methods of PRP extraction and activation varied markedly between studies. Fat graft preparation was comparatively more consistent. Methods of PRP and fat mixing differed significantly, especially with regards to relative volume/volume ratios. CONCLUSIONS Our study represents the first systematic review of methodological factors in autologous PRP and fat cotransplantation. It demonstrates that technical factors in graft preparation and administration vary significantly between in vivo studies. Such methodological heterogeneity may explain observed differences in experimental and clinical outcomes. Reporting of key procedural information is inconsistent and often inadequate. These issues make meaningful evaluation of the PRP-enhanced fat grafting literature difficult and may limit its translation into clinical practice.
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Affiliation(s)
- Joshua Luck
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Oliver J Smith
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
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Frautschi RS, Hashem AM, Halasa B, Cakmakoglu C, Zins JE. Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review. Aesthet Surg J 2017; 37:353-362. [PMID: 28207031 DOI: 10.1093/asj/sjw178] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Platelet rich plasma (PRP) has attracted attention in a number of surgical fields due to a wide variety of potential clinical benefits. Yet PRP has not gained wide popularity in aesthetic surgery as a result of uncertainty surrounding objective clinical evidence. Objectives We aim to describe the current applications, define preparation and activation, explore effectiveness, and propose a classification system to facilitate comparisons across studies. Methods A comprehensive review of the literature regarding the use of platelet rich plasma in aesthetic surgery was performed. Data gathered included: PRP application, study type, subject number, centrifugation, anticoagulation, activation, PRP composition, and outcomes. Results Thirty-eight reports were identified. Applications included injection into aging skin (29%), scalp alopecia (26%), lipofilling (21%), fractional laser (13%), and facial surgery (11%). The majority of studies (53%) were case series without controls. Leucocytes were sparsely defined (32%). The concentration of injected and/or baseline platelets was rarely clarified (18%). The mechanism of activation was described in 27 studies (71%), while anticoagulation was uncommonly elucidated (47%). While most studies (95%) claim effectiveness, objective measures were only utilized in 17 studies (47%). Conclusions Current studies produce context-dependent results with a lack of consistent reporting of PRP preparation, composition, and activation in aesthetic applications, making meaningful meta-analysis unrealistic. Thus the method of PRP preparation warrants increased attention. We recommend a set of descriptors, FIT PAAW (described below), to produce scientifically grounded conclusions, facilitating a clearer understanding of the situations in which PRP is effective. Level of Evidence 4
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Affiliation(s)
| | - Ahmed M Hashem
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Brianna Halasa
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - James E Zins
- Facial Surgery Section Editor for Aesthetic Surgery Journal
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Riyat H, Touil LL, Briggs M, Shokrollahi K. Autologous fat grafting for scars, healing and pain: a review. Scars Burn Heal 2017; 3:2059513117728200. [PMID: 29799544 PMCID: PMC5965331 DOI: 10.1177/2059513117728200] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Current guidelines suggest a multimodal approach to treating scars but there is no gold standard for treatment; however, there is exciting therapeutic potential for the use of autologous fat grafting (AFG). Functional and aesthetic improvements have been reported, including pain relief and scar quality improvement. AIMS To explore the current evidence regarding the use of AFG in hypertrophic and painful scars. METHODS A systematic review of the literature was conducted using 11 MeSH terms in PubMed, Medline and EMBASE. English studies that used AFG to treat scars in human participants were included. RESULTS A total of 746 studies were found and 23 studies (from 2008 to 2016) were included: five studies were evidence level V; nine studies were evidence level IV; eight were evidence level III; and one study was evidence level II. A total of 1158 patients were assessed for improvement in scar characteristics including colour, thickness, volume, pain and restoration of function at affected sites, following treatment. Positive outcomes were noted for all parameters and a significant improvement in AFG's analgesic effect was recorded in 567 out of 966 patients, P < 0.05. DISCUSSION AFG is a minimally invasive and safe approach to treating scars, a promising alternative to surgical excision. The technique of blunt cannula insertion optimises the release of scar retraction, which contributes to the analgesic effect of this treatment method. The evidence supports current theories of mesenchymal stem cell's regenerative and anti-inflammatory properties responsible for scar healing. There are limited high quality studies to support its use and future randomised controlled trials should be conducted.
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Affiliation(s)
- Harjoat Riyat
- Mersey Regional Centre for Burns and
Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
| | - Leila L. Touil
- Mersey Regional Centre for Burns and
Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
| | - Matthew Briggs
- Faculty of Arts and Creative Industries,
University of Sunderland, Sunderland, Tyne and Wear, UK
| | - Kayvan Shokrollahi
- Mersey Regional Centre for Burns and
Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK
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Martinez‐Zapata MJ, Martí‐Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, Garcia J, Zaror C. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev 2016; 2016:CD006899. [PMID: 27223580 PMCID: PMC9308064 DOI: 10.1002/14651858.cd006899.pub3] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) is a treatment that contains fibrin and high concentrations of growth factors with the potential to improve the healing of chronic wounds. This is the first update of a review first published in 2012. OBJECTIVES To determine whether autologous PRP promotes the healing of chronic wounds. SEARCH METHODS In June 2015, for this first update, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library): Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We also searched for ongoing and unpublished clinical trials in the WHO International Clinical Trials Registry Platform (ICTRP) (searched January 2015). We did not impose any restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared autologous PRP with placebo or alternative treatments for any type of chronic wound in adults. We did not apply any date or language restrictions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology, including two reviewers independently selecting studies for inclusion, extracting data, and assessing risk of bias. MAIN RESULTS The search identified one new RCT, making a total of 10 included RCTs (442 participants, 42% women). The median number of participants per RCT was 29 (range 10 to 117). Four RCTs recruited people with a range of chronic wounds; three RCTs recruited people with venous leg ulcers, and three RCTs considered foot ulcers in people with diabetes. The median length of treatment was 12 weeks (range 8 to 40 weeks).It is unclear whether autologous PRP improves the healing of chronic wounds generally compared with standard treatment (with or without placebo) (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.95 to 1.50; I(2) = 27%, low quality evidence, 8 RCTs, 391 participants). Autologous PRP may increase the healing of foot ulcers in people with diabetes compared with standard care (with or without placebo) (RR 1.22, 95% CI 1.01 to 1.49; I(2) = 0%, low quality evidence, 2 RCTs, 189 participants). It is unclear if autologous PRP affects the healing of venous leg ulcers (RR 1.02, 95% CI 0.81 to 1.27; I(2) = 0% ). It is unclear if there is a difference in the risk of adverse events in people treated with PRP or standard care (RR 1.05, 95% CI 0.29 to 3.88; I(2) = 0%, low quality evidence from 3 trials, 102 participants). AUTHORS' CONCLUSIONS PRP may improve the healing of foot ulcers associated with diabetes, but this conclusion is based on low quality evidence from two small RCTs. It is unclear whether PRP influences the healing of other chronic wounds. The overall quality of evidence of autologous PRP for treating chronic wounds is low. There are very few RCTs evaluating PRP, they are underpowered to detect treatment effects, if they exist, and are generally at high or unclear risk of bias. Well designed and adequately powered clinical trials are needed.
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Affiliation(s)
- Maria José Martinez‐Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
| | | | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
| | - José Angel Expósito
- Agency for Health Quality and Assessment of Catalonia (AQuAS)Roc Boronat, 81‐95BarcelonaCataloniaSpain08805
| | - Ignasi Bolíbar
- Hospital de la Santa Creu i Sant PauEpidemiología Clínica y Salud PúblicaSant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaCatalunyaSpain08041
| | - Luciano Rodríguez
- Banc de Sang i TeixitsTissue BankPasseig Taulat 106‐116BarcelonaCatalunyaSpain080035
| | - Joan Garcia
- Departament de Salut. Generalitat de CatalunyaCentre de Teixits i Teràpia CellularAutovia de Castelldedels, Km 2.7L'Hospitalet de LLobregatBarcelonaCatalunyaSpain08907
| | - Carlos Zaror
- Faculty of Dentistry, Universidad de la FronteraDepartment of Pediatric Dentistry and OrthodonticTemucoChile
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The Use of Autologous Fat Grafting for Treatment of Scar Tissue and Scar-Related Conditions: A Systematic Review. Plast Reconstr Surg 2016; 137:31e-43e. [PMID: 26710059 DOI: 10.1097/prs.0000000000001850] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scar tissue can cause cosmetic impairments, functional limitations, pain, and itch. It may also cause emotional, social, and behavioral problems, especially when it is located in exposed areas. To date, no gold standard exists for the treatment of scar tissue. Autologous fat grafting has been introduced as a promising treatment option for scar tissue-related symptoms. However, the scientific evidence for its effectiveness remains unclear. This systematic review aims to evaluate the available evidence regarding the effectiveness of autologous fat grafting for the treatment of scar tissue and scar-related conditions. METHODS A systematic literature review was performed using MEDLINE, Cochrane Library, EMBASE, and Web of Science. No language restrictions were imposed. RESULTS Twenty-six clinical articles were included, reporting on 905 patients in total. Meta-analysis was not performed because of the heterogeneous methodology demonstrated among the articles. Main outcome measures were scar appearance and skin characteristics, restoration of volume and/or (three-dimensional) contour, itch, and pain. All publications report a beneficial effect of autologous fat grafting on scar tissue. There is statistical significant improvement of the scar appearance, skin characteristics, and pain. Itch and restoration of volume and three-dimensional contour also improved. CONCLUSIONS Autologous fat grafting is used to improve a variety of symptoms related to scar tissue. This systematic review suggests that autologous fat grafting provides beneficial effects with limited side effects. However, the level of evidence and methodological quality are quite low. Future randomized controlled trials with a methodologically strong design are necessary to confirm the effects of autologous fat grafting on scar tissue and scar-related conditions.
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Krakowski AC, Totri CR, Donelan MB, Shumaker PR. Scar Management in the Pediatric and Adolescent Populations. Pediatrics 2016; 137:e20142065. [PMID: 26743819 DOI: 10.1542/peds.2014-2065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/24/2022] Open
Abstract
For most children and adolescents who have developed symptomatic scars, cosmetic concerns are only a portion of the motivation that drives them and their caregivers to obtain treatment. In addition to the potential for cosmetic disfigurement, scars may be associated with a number of physical comorbidities including hypertrichosis, dyshidrosis, tenderness/pain, pruritus, dysesthesias, and functional impairments such as contractures, all of which may be compounded by psychosocial factors. Although a plethora of options for treating scars exists, specific management guidelines for the pediatric and adolescent populations do not, and evidence must be extrapolated from adult studies. New modalities such as the scar team approach, autologous fat transfer, and ablative fractional laser resurfacing suggest a promising future for children who suffer symptomatically from their scars. In this state-of-the-art review, we summarize cutting-edge scar treatment strategies as they relate to the pediatric and adolescent populations.
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Affiliation(s)
- Andrew C Krakowski
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California;
| | - Christine R Totri
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Matthias B Donelan
- Department of Plastic Surgery, Shriner's Hospital for Children, Boston, Massachusetts; and
| | - Peter R Shumaker
- Department of Dermatology, Naval Medical Center, San Diego, California
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Lynch MD, Bashir S. Applications of platelet-rich plasma in dermatology: A critical appraisal of the literature. J DERMATOL TREAT 2015; 27:285-9. [DOI: 10.3109/09546634.2015.1094178] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ackermann M, Wettstein R, Senaldi C, Kalbermatten DF, Konerding MA, Raffoul W, Erba P. Impact of platelet rich plasma and adipose stem cells on lymphangiogenesis in a murine tail lymphedema model. Microvasc Res 2015; 102:78-85. [PMID: 26365474 DOI: 10.1016/j.mvr.2015.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 09/06/2015] [Accepted: 09/06/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymphedema is an underdiagnosed pathology which in industrialized countries mainly affects cancer patients that underwent lymph node dissection and/or radiation. Currently no effective therapy is available so that patients' life quality is compromised by swellings of the concerned body region. This unfortunate condition is associated with body imbalance and subsequent osteochondral deformations and impaired function as well as with an increased risk of potentially life threatening soft tissue infections. METHODS The effects of PRP and ASC on angiogenesis (anti-CD31 staining), microcirculation (Laser Doppler Imaging), lymphangiogenesis (anti-LYVE1 staining), microvascular architecture (corrosion casting) and wound healing (digital planimetry) are studied in a murine tail lymphedema model. RESULTS Wounds treated by PRP and ASC healed faster and showed a significantly increased epithelialization mainly from the proximal wound margin. The application of PRP induced a significantly increased lymphangiogenesis while the application of ASC did not induce any significant change in this regard. CONCLUSIONS PRP and ASC affect lymphangiogenesis and lymphedema development and might represent a promising approach to improve regeneration of lymphatic vessels, restore disrupted lymphatic circulation and treat or prevent lymphedema alone or in combination with currently available lymphedema therapies.
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Affiliation(s)
- Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Reto Wettstein
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Christopher Senaldi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Moritz A Konerding
- Institute of Functional and Clinical Anatomy, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Paolo Erba
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Department of ORL, Head and Neck Surgery, University Hospital of Bern, Bern, Switzerland.
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Leo MS, Kumar AS, Kirit R, Konathan R, Sivamani RK. Systematic review of the use of platelet-rich plasma in aesthetic dermatology. J Cosmet Dermatol 2015. [PMID: 26205133 DOI: 10.1111/jocd.12167] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Platelet-rich plasma (PRP) is a highly concentrated autologous solution of plasma prepared from a patient's own blood. PRP contains platelets that are purported to release numerous growth factors that may be valuable in numerous dermatologic applications. Here, we review systematically the clinical cosmetic applications of PRP including: androgenetic alopecia, scar revision, acne scars, skin rejuvenation, dermal augmentation, and striae distensae to understand the potential and best practices for PRP use. A systematic search was conducted on three databases: Pubmed, Embase, and Web of Science. Publications were included if they were in English, investigated the clinical applications of PRP in aesthetic dermatology and reported clinical results either as case reports or clinical studies. There were a total of 22 manuscripts that fulfilled these criteria. Four evaluated hair-related applications, eight evaluated the treatment of scars and postprocedure recovery, eight evaluated skin rejuvenation and dermal augmentation, and two evaluated treatment of striae distensae. PRP is a relatively new treatment modality with studies suggesting its utility in aesthetic dermatology. The combination of PRP with other therapies is particularly interesting. Future studies should include controls, including incorporation of split-face comparisons, to reduce intersubject variability.
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Affiliation(s)
- Michael S Leo
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Alur S Kumar
- Department of Dermatology, Owaisi Hospital and Research Centre, Hyderabad, India
| | - Raj Kirit
- Sainath Skin Clinic, Himayathnagar, Hyderabad, India
| | - Rajyalaxmi Konathan
- Department of Dermatology,Venereology, and Leprosy, Central Hospital South Central Railway, Hyderabad, India
| | - Raja K Sivamani
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
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Nami N, Feci L, Napoliello L, Giordano A, Lorenzini S, Galeazzi M, Rubegni P, Fimiani M. Crosstalk between platelets and PBMC: New evidence in wound healing. Platelets 2015; 27:143-8. [PMID: 26030799 DOI: 10.3109/09537104.2015.1048216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Platelet-derived products have proven useful in accelerating healing processes and tissue regeneration. However, despite their widespread use in clinical practice, the cellular and molecular mechanisms involved have not yet been completely clarified. Recent studies show that interaction between platelet gel (PG) and peripheral blood mononuclear cells (PBMC) can result in activation of PBMC and production of several cytokines involved in wound healing and tissue repair. The aim of our study was to analyze whether crosstalk between platelets and PBMC can influence wound healing by modulating release of VEGF, bFGF and IL-10 by PBMC. Cultures of PBMC alone and co-cultures with autologous PG of 24 healthy volunteers were incubated under normoxia for 24 h. VEGF, bFGF and IL-10 concentration and expression were then analyzed in supernatants by ELISA and by real-time RT-PCR. We observed a down-regulation of VEGF and bFGF release and an up-regulation of IL-10 release in co-cultures of PBMC and PG. Platelets are not only important in the early stages of the healing process (clot formation, direct release of growth factors), but also can influence the whole process of tissue regeneration by modulating synthesis and release of VEGF, bFGF and IL-10 by PBMC. These effects could give platelets a new key role in the control of healing processes and provide insights into the clinical success of platelet-derived products in many medical fields.
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Affiliation(s)
- Niccolò Nami
- a Department of Medical , Surgical and Neuro Sciences, Dermatology Section, University of Siena , Siena , Italy
| | - Luca Feci
- a Department of Medical , Surgical and Neuro Sciences, Dermatology Section, University of Siena , Siena , Italy
| | - Luca Napoliello
- b Department of Medical , Surgical and Neuro Sciences, Human Pathology Section, University of Siena , Siena , Italy
| | - Antonio Giordano
- b Department of Medical , Surgical and Neuro Sciences, Human Pathology Section, University of Siena , Siena , Italy .,c Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University , Philadelphia , PA USA , and
| | - Sauro Lorenzini
- d Department of Medical , Surgical and Neuro Sciences, Rheumatology Section, University of Siena , Siena , Italy
| | - Mauro Galeazzi
- d Department of Medical , Surgical and Neuro Sciences, Rheumatology Section, University of Siena , Siena , Italy
| | - Pietro Rubegni
- a Department of Medical , Surgical and Neuro Sciences, Dermatology Section, University of Siena , Siena , Italy
| | - Michele Fimiani
- a Department of Medical , Surgical and Neuro Sciences, Dermatology Section, University of Siena , Siena , Italy
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Abstract
Platelet-rich plasma (PRP) is a fraction of blood plasma with a platelet concentration above baseline. After activation of the platelets, growth factors are released, which are involved in wound-healing processes. Application of a multitude of growth factors seems to boost the healing process. In this review the authors provide a comprehensive overview of the many different aspects of PRP; this is followed by a short outline of the evidence for a wide range of applications and finally narrowing down to a more in-depth analysis of the literature on the potential use of PRP in burn treatment. The authors performed an extensive search on PRP and the different biological, as well as practical aspects for the different applications. Furthermore, we performed a systematic search on PRP in the treatment of burn wounds. A high variety exists in PRP products, procedures, and content. This makes interpretation and comparison of the evidence difficult. PRP has been reported to have beneficial effects on wound healing in different fields of surgery and in the treatment of acute, chronic, and diabetic wounds. Literature on the use of PRP in burns is scarce. Separate growth factors have shown beneficial results in the treatment of burns. Furthermore, an animal study and several case reports showed improved burn wound-healing time after the application of PRP. A deep dermal burn could benefit from PRP through its hemostatic antimicrobial abilities and the positive effects seen in wound healing. However, burn patients have an altered physiological state and it is unknown how this may affect platelet function and quality. Furthermore, the effect of PRP on scarring has not been evaluated properly. Future research is needed to elucidate the role of PRP in the treatment of burns.
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ZHU JIANGTING, XUAN MIN, ZHANG YANI, LIU HONGWEI, CAI JINHUI, WU YANHONG, XIANG XIAOFEI, SHAN GUIQIU, CHENG BIAO. The efficacy of autologous platelet-rich plasma combined with erbium fractional laser therapy for facial acne scars or acne. Mol Med Rep 2013; 8:233-7. [DOI: 10.3892/mmr.2013.1455] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/20/2013] [Indexed: 11/06/2022] Open
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