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Soares CS, Dias IR, Barros LC, Pires MDA, Carvalho PP. Management of canine wounds using platelet-rich fibrin (PRF) biomaterial. A case series report. Vet Med Sci 2024; 10:e1236. [PMID: 38546115 PMCID: PMC10976423 DOI: 10.1002/vms3.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/18/2023] [Accepted: 07/21/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The increasing interest in platelet-based therapies has underwritten the development of novel veterinary regenerative treatments. The haemoderivative platelet-rich fibrin (PRF) comprises abundant concentrations of platelets and leucocytes, above the physiologic baseline, which are considered essential elements for wound regeneration, stimulating local angiogenesis, cellular migration, proliferation and differentiation, considered essential for skin repair. OBJECTIVES This study aimed to describe the treatment of eight dogs with naturally occurring cutaneous wounds, where autologous PRF therapy was applied, using a protocol developed by our group. METHODS Eight dogs, aged between 7-month and 9-year old, from different breeds and sexes, were enrolled in this study. Four of these wounds were clinically infected. In three cases, two PRF treatments were performed during the first week of treatment, followed by single weekly treatments from the second week onwards, until exophytic granulation tissues were present. In each case, the treatment was finalized only when complete wound closure was achieved. Wounds did not receive topical antiseptics, antibiotics or topical drugs to promote wound healing during the treatment. RESULTS PRF-grafting treatments were well tolerated in all treated wounds, inducing significant granulation tissue formation. PRF clots acted as a natural tissue filler, promoting epithelization and wound closure, without the requirement of topical antimicrobial/antiseptics application, or additional surgical debridement. Evident skin contraction was recorded in larger injuries and all the treatments resulted in vestigial aesthetic scars where hair growth was also observed. CONCLUSIONS PRF-therapy obtained promising results, as an alternative wound treatment, revealing a biological regenerative action, prompting the natural skin healing process.
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Affiliation(s)
- Carla S. Soares
- Animal and Veterinary Research Centre (CECAV), AL4AnimaLS, Department of Veterinary Sciences, School of Agricultural and Veterinary SciencesUniversity of Trás‐os‐Montes e Alto Douro (UTAD)Vila RealPortugal
- VetLamaçães, Veterinary ClinicBragaPortugal
- Center for Investigation Vasco da Gama (CIVG), Department of Veterinary SciencesEscola Universitária Vasco da GamaCoimbraPortugal
| | - Isabel R. Dias
- Animal and Veterinary Research Centre (CECAV), AL4AnimaLS, Department of Veterinary Sciences, School of Agricultural and Veterinary SciencesUniversity of Trás‐os‐Montes e Alto Douro (UTAD)Vila RealPortugal
| | | | - Maria dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), AL4AnimaLS, Department of Veterinary Sciences, School of Agricultural and Veterinary SciencesUniversity of Trás‐os‐Montes e Alto Douro (UTAD)Vila RealPortugal
| | - Pedro P. Carvalho
- Vetherapy – Research and Development in BiotechnologyCoimbraPortugal
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Wu Y, Peng G, Wang Y, Chen J, Zhang B, Tang J, Cheng B. Clinical efficacy of blood derivatives on wound healing: A systematic review and network meta-analysis. Int Wound J 2024; 21:e14622. [PMID: 38158884 PMCID: PMC10961890 DOI: 10.1111/iwj.14622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
This study aims to evaluate the clinical effects of different blood derivatives on wound healing using network meta-analysis. PubMed, Embase, OVID, Web of Science, SCOPUS and Cochrane Central were searched to obtain studies about blood derivatives on wound healing until October 2023. R 4.2.0 and Stata 15.0 softwares were used for data analysis. Forty-four studies comprising 5164 patients were included. The results of network meta-analysis showed that the healing area from high to low was GF + ORCCB, ORCCB, GF, PRF, Unnas paste dressing, APG, PRP injection, PRP, PRP + thrombin gel, PPP, HPL, CT. The healing time from low to high was PRP + thrombin gel, GF, PRP, PC + K, PC, APG, PRF, CT, Silver sulfadiazine ointment. The number of patients cured from high to low was APG, PRP injection, PRP, Aurix, PRF, Leucopatch, HPL, Antimicrobial Ointment Dressing, CT, 60 μg/cm2 repifermin, 120 μg/cm2 repifermin, AFG, PPP. The order of analgesic effect from high to low was AFG, Aminogam gel, PRF, PRP, Oxidised oil, APG, GF, CT. The order of the number of wound infection cases from low to high is APG, 20 μg/cm2 repifermin, 60 μg/cm2 repifermin, PRP, LeucoPatch, CT, PPP, Antiseptic ointment dressing. Healing area: GF + ORCCB had the best effect; Healing time: PRP + thrombin gel took the shortest time. The number of cured patients and the reduction of wound infection: APG has the best effect. Analgesic effect: AFG has the best effect. More studies with large sample sizes are needed to confirm the above findings.
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Affiliation(s)
- Yanhong Wu
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Guang Peng
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Yuzhi Wang
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Jianwu Chen
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Bin Zhang
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Jianbing Tang
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Biao Cheng
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
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Tang B, Huang Z, Zheng X. Impact of autologous platelet concentrates on wound area reduction: A meta-analysis of randomized controlled trials. Int Wound J 2023; 20:4384-4393. [PMID: 37464541 PMCID: PMC10681409 DOI: 10.1111/iwj.14310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
This meta-analysis aimed to evaluate the impact of autologous platelet concentrates (APCs) on wound area reduction based on randomized controlled trials (RCTs). A comprehensive search was conducted in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Web of Science, and the Cochrane Library to identify relevant literature. The primary outcome measure was the percentage of wound area reduction. Secondary outcome measures included wound healing time and the incidence of infection. A total of 14 studies were included in the meta-analysis. The results showed that the percentage of wound area reduction was significantly greater in the APCs group compared to conventional treatments (standardized mean difference [SMD] 1.98, 95% confidence interval [CI]: 1.27-2.68, p < 0.001). Subgroup analysis revealed that the percentage of wound area reduction varied based on wound location, follow-up duration, and type of APCs used. The healing time and incidence of infection presented no significant difference between the two groups. The findings suggest that APCs can effectively reduce wound areas when compared to conventional treatments, without increasing the risk of infection. In addition, the effectiveness of APCs in wound area reduction may vary depending on factors such as wound location, type of APCs used, and follow-up duration.
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Affiliation(s)
- Bangli Tang
- Department of Dermatology, Mianyang Central HospitalSchool of Medicine University of Elctronic Science and Technology of ChinaMianyangChina
| | - Zhongkui Huang
- Department of Dermatology, Mianyang Central HospitalSchool of Medicine University of Elctronic Science and Technology of ChinaMianyangChina
| | - Xuhai Zheng
- Department of Dermatology, Mianyang Central HospitalSchool of Medicine University of Elctronic Science and Technology of ChinaMianyangChina
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Knightly N, Lee C, O’Brien L, Qayyum T, Hurley C, Kelly J. Role for platelet rich plasma as an adjuvant therapy in wound healing and burns. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Abstract
Background
Platelet rich plasma (PRP) contains high concentrations of growth factors. Intuitively, these were thought to be of potential benefit in healing of chronic wounds, skin grafts and graft donor sites. This was echoed in retrospective studies and an individual case basis but had not been randomized.
Methods
A systematic search was carried out by two individuals, independently, on the MEDLINE, EMBASE and COCHRANE databases, according to PRISMA guidelines. All data analysis and statistics was pooled and analysed using the Cochrane RevMan Software.
Results
Split thickness grafts have been described by numerous authors, but PRP use did not offer a significant advantage in graft take in pooled results (MD 5.83, 95% CI − 0.69 to 12.25, random-effects, p = 0.08). The analysis of included randomized controlled trials has shown favourable split-thickness skin graft donor site healing in the PRP group (MD − 5.55, 95% CI − 7.40 to − 3.69, random-effects, p = < 0.00001) compared to the control group. For carpal tunnel syndrome, the pooled results showed no difference in functional scores vs steroid injections (SMD − 0.68, 95% CI − 1.47 to 0.10, randomeffects, p = 0.09) or indeed splinting groups.
Conclusions
With the current body of evidence, we conclude that the use of PRP as an adjuvant therapy in skin grafts, burns, carpal tunnel surgery or scars cannot be rationalised. A potential use of PRP is in donor site management but the cost of this would be difficult to justify.
Level of evidence: Not ratable.
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A Randomized Controlled Trial of Three Advanced Wound Dressings in Split-Thickness Skin Grafting Donor Sites-A Personalized Approach? J Pers Med 2022; 12:jpm12091395. [PMID: 36143180 PMCID: PMC9506097 DOI: 10.3390/jpm12091395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Split-thickness skin grafting (STSG) is a frequently used reconstructive technique, and its donor site represents a standardized clinical model to evaluate wound dressings. We compared hydroactive nanocellulose-based, silver-impregnated and ibuprofen-containing foam wound dressings. Methods: A total of 46 patients scheduled for elective surgery were evaluated on the STSG donor site for wound healing (time-to-healing, Hollander Wound Evaluation Scale), pain level (Visual Analogue Scale), and handling (ease of use), as well as scar quality (Patient Scar Assessment Scale, Vancouver Scar Scale) after 3, 6 and 12 months. Results: Almost all dressings compared equally well. We observed statistically relevant differences for pain level favoring the ibuprofen-containing dressing (p = 0.002, ΔAIC = 8.1), and user friendliness in favor of nanocellulose (dressing removal: p = 0.037, ΔAIC = 2.59; application on patient: p = 0.042, ΔAIC = 2.33; wound adhesion: p = 0.017, ΔAIC = 4.16; sensation on skin: p = 0.027, ΔAIC = 3.21). We did not observe any differences for wound healing across all groups. Treatment with hydroactive nanocellulose and the ibuprofen-containing foam revealed statistically relevant better scar appearances as compared to the silver wound dressing (p < 0.001, ΔAIC = 14.77). Conclusion: All wound dressings performed equally well, with the detected statistical differences hinting future directions of clinical relevance. These include the reserved use of silver containing dressings for contaminated or close to contaminated wounds, and the facilitated clinical application of the nanocellulose dressing, which was the only suitable candidate in this series to be impregnated with a range of additional therapeutic agents (e.g., disinfectants and pain-modulating drugs). Personalized donor site management with the tested dressings can meet individual clinical requirements after STSG and improve management strategies and ultimately patient outcomes.
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Elfahl AM, Abd El Baky AM, Yousef MT, Elgohary HM. High Versus Low Frequency Transcutaneous Electric Nerve Stimulation On Chronic Venous Lower Limb Ulceration Randomized Controlled Trial. INT J LOW EXTR WOUND 2022:15347346221093860. [PMID: 35422171 DOI: 10.1177/15347346221093860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The major objective of the current paper is to trace and investigate which method is more effective whether the high or the low Transcutaneous electric Nerve Stimulations (TENS) on venous ulcers. A single-blinded, randomized, and controlled trial was done successfully. Sixty venous ulcer patients were divided randomly into three groups; Group (A): control group, Group(B): High-TENS group, and Group(C): Low-TENS group. Group (A), contains twenty participants who received routine medical care and dressing. As for group (B), includes twenty participants who obtained high-frequency TENS; Frequency (80-120) HZ, Intensity (15 - 30 amp), Pulse duration 250 Micro sec, 60 min per session with routine medical care and dressing. The third group (c) L-TENS, encompasses twenty participants who received low-frequency TENS (1-5) HZ; Intensity (30 -80 amp), Pulse duration 250 Micro sec, 60 min per session with routine medical care and dressing. All the participants were examined before and after two months of intervention; four weeks (post1), then after eight weeks (post2). Participants were examined by using (image j) to measure the ulcer area. Saline was used for measuring the ulcer volume, and a visual analog scale was adopted to evaluate pain. After drawing a comparison among the three groups after four weeks and after eight weeks of treatment, a statistically significant decrease (P <0.05) in wound surface area, wound volume, and pain in favor of L-TENS was noticed. It has been found that L- TENS is more effective than H -TENS and is highly recommended in the treatment protocol for such debilitating conditions.
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Affiliation(s)
- Ahmed M Elfahl
- Physical Therapy for Burn and Surgery Department, Faculty of Physical Therapy, 110120Modern University for Information and Technology, Cairo, Egypt
| | - Amal M Abd El Baky
- Professor of Physical Therapy for Surgery and Vice Dean for Postgraduate Studies and Scientific Research, Faculty of Physical Therapy, 531226Cairo University, Cairo, Egypt
| | - Mohamed T Yousef
- Assistant professor and chairman of Endo Vascular Surgery Department, Al-Mataria Teaching Hospital, Cairo, Egypt
| | - Hany M Elgohary
- Assistant professor of Physical Therapy for Surgery, Faculty of Physical Therapy, 531226Cairo University, Cairo, Egypt
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Ziauddin, Hussain T, Nazir A, Mahmood U, Hameed M, Ramakrishna S, Abid S. Nanoengineered therapeutic scaffolds for burn wound management. Curr Pharm Biotechnol 2022; 23:1417-1435. [PMID: 35352649 DOI: 10.2174/1389201023666220329162910] [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: 05/31/2021] [Revised: 10/05/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Wound healing is a complex process, and selecting an appropriate treatment is crucial and varies from one wound to another. Among injuries, burn wounds are more challenging to treat. Different dressings and scaffolds come into play when skin is injured. These scaffolds provide the optimum environment for wound healing. With the advancements of nanoengineering, scaffolds have been engineered to improve wound healing with lower fatality rates. OBJECTIVES Nanoengineered systems have emerged as one of the promising candidates for burn wound management. This review paper aims to provide an in-depth understanding of burn wounds and the role of nanoengineering in burn wound management. The advantages of nanoengineered scaffolds, their properties, and their proven effectiveness have been discussed. Nanoparticles and nanofibers-based nanoengineered therapeutic scaffolds provide optimum protection, infection management, and accelerated wound healing due to their unique characteristics. These scaffolds increase cell attachment and proliferation for desired results. RESULTS The literature review suggested that the utilization of nanoengineered scaffolds has accelerated burn wound healing. Nanofibers provide better cell attachment and proliferation among different nanoengineered scaffolds due to their 3D structure mimics the body's extracellular matrix. CONCLUSION With the application of these advanced nanoengineered scaffolds, better burn wound management is possible due to sustained drug delivery, better cell attachment, and an infection-free environment.
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Affiliation(s)
- Ziauddin
- Electrospun Materials & Polymeric Membranes Research Group, National Textile University, Pakistan
| | - Tanveer Hussain
- Electrospun Materials & Polymeric Membranes Research Group, National Textile University, Pakistan
| | - Ahsan Nazir
- Electrospun Materials & Polymeric Membranes Research Group, National Textile University, Pakistan
| | - Urwa Mahmood
- Electrospun Materials & Polymeric Membranes Research Group, National Textile University, Pakistan
| | - Misbah Hameed
- Department of Pharmaceutics, Faculty of pharmaceutical science, Government College University, Faisalabad, Pakistan
| | - Seeram Ramakrishna
- Center for Nanofibers & Nanotechnology (CNN), National University of Singapore (NUS), Singapore
| | - Sharjeel Abid
- Electrospun Materials & Polymeric Membranes Research Group, National Textile University, Pakistan
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OUP accepted manuscript. PAIN MEDICINE 2022; 23:1733-1749. [DOI: 10.1093/pm/pnac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/14/2022]
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García-Sánchez JM, Mirabet Lis V, Ruiz-Valls A, Pérez-Plaza A, Sepúlveda Sanchis P, Pérez-Del-Caz MD. Platelet rich plasma and plasma rich in growth factors for split-thickness skin graft donor site treatment in the burn patient setting: A randomized clinical trial. Burns 2021; 48:1662-1670. [PMID: 34952738 DOI: 10.1016/j.burns.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Management of donor site morbidity in the setting of split thickness skin graft (STSG) is of crucial importance with no superior wound dressing described to date and the growing need of decreasing epithelializing time. The purpose of the study was to compare the standard of care using a hydrocolloid dressing to platelet rich plasma (PRP) and plasma rich in growth factors (PRGF) in order to determine its therapeutic potential in this setting. METHODS A randomized clinical trial was conducted in which each patient served as its own control. PRGF was obtained by means of freeze-thaw out of the PRP from the subject of the study. Patients from the study had three donor sites and each donor site received either to PRP, PRGF or the standard of care, hydrocolloid. The main variable was time to epithelialization, and secondary variables subject to study were pain, quality of the scar, complications and cost. RESULTS 20 patients were recruited with a total number of 60 donor sites to study. On the 8th post-operative day 55% and 45% of the sites treated with PRP and PRGF, respectively, complete epithelialization was observed as compared to 20% of the sites treated with hydrocolloid, statistical significance was achieved between the latter two (p = 0.036). The areas treated with PRP and PRGF received inferior values on the visual analog scale on post-op day 5 and 8 compared to hydrocolloid. Values on wound healing metrics were lower in the PRP when compared to hydrocolloid. No adverse effects were recorded. CONCLUSION Donor site of STSG treated with PRP in the setting of the burn patient decreased time to epithelialization. In our study a better pain control and in scar quality was observed in both, the PRP and PRGF group.
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Affiliation(s)
| | - Vicente Mirabet Lis
- Center for Blood Transfusion and Tissue Bank of Valencian Community, Valencia, Spain
| | - Alejandro Ruiz-Valls
- Department of Plastic and Reconstructive Surgery and Burns, La Fe Hospital, Valencia, Spain.
| | - Aranzazu Pérez-Plaza
- Department of Plastic and Reconstructive Surgery and Burns, La Fe Hospital, Valencia, Spain
| | - Pilar Sepúlveda Sanchis
- Regenerative Medicine and Heart Transplantation Unit, Health Research Institute Hospital La Fe, Valencia, Spain
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Autologous platelet-rich fibrin (PRF) augmentation as an add-on therapy in deep surgical site infections (dSSIs) after instrumented spinal surgery: preliminary results of a single institution case series. Acta Neurochir (Wien) 2021; 163:2761-2767. [PMID: 34431000 PMCID: PMC8437872 DOI: 10.1007/s00701-021-04952-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/22/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Deep surgical site infections (dSSIs) after instrumented spinal surgery pose major therapeutic challenges. Standard treatment involves surgical debridement, wound drainage, and long-term antibiotic administration. Autologous platelet-rich fibrin (PRF) constitutes a biomaterial obtained from patients' own blood that contains leukocytes, chemokines and growth factors boosting cicatrization. Due to favorable results reported from other surgical disciplines such as dentistry, orthopedics, maxillofacial and plastic surgery using PRF, the authors hypothesized that PRF augmentation will promote wound healing in dSSIs. OBJECTIVE To report our preliminary results on the safety and efficacy of autologous-PRF as an add-on therapy on a pilot case series of persistent dSSI after instrumented spinal surgery. METHODS Among the 293 patients who underwent dorsal decompression and stabilization of the cervical, thoracic, and lumbar spine due to degenerative diseases in our department, 12 patients (4%) presented persisting dSSI after standard wound debridement and antibiotic treatment. PRF augmentation was used during a second surgical revision as an add-on therapy to standard debridement. In all cases, the wound was primarily closed without drains. RESULTS Wound healing was completed between 14 and 21 days after the second surgical revision in all patients. At a median follow-up of 8 months (range: 6 to 18 months), no recurrence of dSSI nor complications were encountered in any case. CONCLUSIONS Our preliminary results suggest that PRF augmentation in persistent dSSI after instrumented spinal surgery appears to be a safe and effective strategy to promote wound healing. Prospective controlled studies are required to define the efficiency of PRF more clearly in both treating and preventing dSSI.
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Soares CS, Dias IR, Pires MA, Carvalho PP. Canine-Origin Platelet-Rich Fibrin as an Effective Biomaterial for Wound Healing in Domestic Cats: A Preliminary Study. Vet Sci 2021; 8:vetsci8100213. [PMID: 34679043 PMCID: PMC8539014 DOI: 10.3390/vetsci8100213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 12/28/2022] Open
Abstract
Platelet-rich fibrin (PRF) is a recent platelet-based biomaterial, poised as an innovative regenerative strategy for the treatment of wounds from different etiologies. PRF is defined as a biodegradable scaffold containing elevated amounts of platelets and leukocytes having the capability to release high concentrations of bioactive structural proteins and acting as a temporal release healing hemoderivative. This study aimed to evaluate the performance of canine-origin PRF, obtained from blood of screened donors, as a regenerative biomaterial suitable for the treatment of critical wounds in felines. Four short-hair felines with naturally occurring wounds were enrolled in this study. Three of the wounds were considered infected. Each PRF treatment was the result of the grafting of newly produced PRFs at the recipient area. The PRF treatment was initially performed two to three times per week, followed by single weekly treatments. The study was finalized when complete wound closure was achieved. No topical antimicrobial/antiseptic treatment was applied. The present research demonstrated that xenogenic PRFs significantly induced healthy vascularized granulation tissue in lesions with soft tissue deficit, also prompting the epithelization at the injured site. No rejection, necrosis, or infection signs were recorded. Additionally, PRF-therapy was revealed to be a biological cost-effective treatment, accelerating the wound healing process.
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Affiliation(s)
- Carla S. Soares
- Laboratory of Histology and Anatomical Pathology, University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (C.S.S.); (M.A.P.)
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal;
- CECAV—Centre for Animal Sciences and Veterinary Studies, UTAD, 5000-801 Vila Real, Portugal
| | - Isabel R. Dias
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal;
- CECAV—Centre for Animal Sciences and Veterinary Studies, UTAD, 5000-801 Vila Real, Portugal
| | - Maria A. Pires
- Laboratory of Histology and Anatomical Pathology, University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (C.S.S.); (M.A.P.)
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal;
- CECAV—Centre for Animal Sciences and Veterinary Studies, UTAD, 5000-801 Vila Real, Portugal
| | - Pedro P. Carvalho
- CIVG—Vasco da Gama Research Center, University School Vasco da Gama—EUVG, Av. José R. Sousa Fernandes, Campus Universitário, Lordemão, 3020-210 Coimbra, Portugal
- Vetherapy-Research and Development in Biotechnology, 3020-210 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239444444
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Capion SC, Jørgensen HBL, Ågren MS, Daugaard H, Ribel-Madsen S, Marando D, Johansson PI, Salado J, Halschou-Jensen PM, Borgwardt A, Andersen JR. The wound healing effect of local leukocyte platelet-rich plasma after total hip arthroplasty: A randomized controlled trial. Wound Repair Regen 2021; 29:988-995. [PMID: 34546614 DOI: 10.1111/wrr.12967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/17/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022]
Abstract
Rapid wound closure is important after arthroplasty procedures to prevent postoperative complications. Platelets are rich in growth factors and leukocytes contribute to innate immunity. We hypothesized that topical leukocyte platelet-rich plasma (L-PRP) derived from the blood of patients would be beneficial to wound healing. In this randomized controlled trial, patients subjected to elective total hip arthroplasty (THA) were assigned by concealed allocation either L-PRP application onto the sutured fascia or no application (control) after the THA intervention. In addition, all patients received 1.5 g protein/kg, 5 g L-arginine, 500 mg vitamin C and 44 mg zinc daily over the 4-week postoperative period to obtain optimal nutrition. The primary endpoint was complete healing of the skin incision. The secondary endpoints were blood transfusions, length of hospital stay, pain and wound infections. Sixteen patients in the L-PRP group and 17 patients in the control group completed the trial. L-PRP treatment accelerated complete wound healing after 3 weeks (seven in the L-PRP group vs. zero in the control group, p = 0.003) and after 4 weeks (12 in the L-PRP group vs. six in the control group, p = 0.037). No postoperative superficial wound infections occurred within 4 weeks, and there were no significant differences in the other secondary outcomes. L-PRP generated in 10 sex-matched healthy volunteers revealed increased concentrations of platelets (5.8-fold) and leukocytes (2.3-fold) compared with those in whole blood. Furthermore, the concentration of keratinocyte mitogen epidermal growth factor in L-PRP (380 ± 130 pg/ml, mean ± SD) was higher (p < 0.001) than that in serum (130 ± 26 pg/ml). In conclusion, a single intraoperative local application of L-PRP promoted wound healing after THA, possibly mediated by EGF receptor agonists.
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Affiliation(s)
- Susanne Clemen Capion
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Henrietta B L Jørgensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Magnus S Ågren
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Daugaard
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Søren Ribel-Madsen
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Debora Marando
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - José Salado
- Blood Bank, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Arne Borgwardt
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
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Brewer CF, Smith A, Miranda BH. The use of platelet-rich products for skin graft donor site healing: a systematic review and meta-analysis. J Plast Surg Hand Surg 2021; 55:133-140. [PMID: 33190577 DOI: 10.1080/2000656x.2020.1846544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/29/2020] [Indexed: 01/13/2023]
Abstract
Split thickness skin grafting is a common reconstructive technique which carries unavoidable donor site morbidity. The aim of this systematic review and meta-analysis is to present the evidence for the use of platelet rich plasma as an adjunct to donor site wound healing. A comprehensive literature search was performed, according to PRISMA guidelines from inception to August 2020, for studies regarding platelet rich plasma and skin graft donor site healing. Animal studies, case series of less than three cases and studies reporting histological outcomes only were excluded. The literature search identified 114 articles. After applying the exclusion criteria, four randomised control trials and two case-control studies remained, incorporating a total of 218 wounds in 139 patients. Four out of six studies reported total healing times for donor site wounds. Pooled analysis showed a significant reduction in healing time when donor wounds were treated with PRP versus controls [MD 5.95, 95% CI 5.04-6.85, p < 0.001]. Of the five studies which reported pain at dressing change, four showed significantly reduced pain scores for the platelet rich plasma treated wounds versus control. There were no significant complications recorded in the treated wounds. The current evidence basis for platelet rich plasma in donor site healing is limited by heterogeneous methodology and reporting outcomes and low powered studies. Nevertheless, the preponderance of data supports its use for accelerating wound healing and reducing pain at dressing change. These preliminary findings need to be substantiated with higher powered randomised controlled trials with standardised PRP manufacture and reporting structures.
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Affiliation(s)
- Christopher F Brewer
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Alexander Smith
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Ben H Miranda
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
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Affiliation(s)
- Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Massimo Papi
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Kittipan Rerkasem
- NCD Centre of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Autologous Matrix of Platelet-Rich Fibrin in Wound Care Settings: A Systematic Review of Randomized Clinical Trials. J Funct Biomater 2020; 11:jfb11020031. [PMID: 32422949 PMCID: PMC7353494 DOI: 10.3390/jfb11020031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 01/13/2023] Open
Abstract
Platelet-rich fibrin (PRF) consists of a matrix that provides the necessary elements for wound healing, acting as a biodegradable scaffold for cell migration, proliferation, and differentiation, in addition to the delivery of growth factors and angiogenesis. This study aims to determine the effectiveness of the autologous PRF in the treatment of wounds of different etiologies. We carried out a systematic review of randomized clinical trials, guided by the recommendations of the Cochrane Collaboration using the following databases: Pubmed/MEDLINE, EMBASE, Web of Science, and CENTRAL. The search strategy resulted in the inclusion of ten studies that evaluated the use of PRF dressings for the healing of acute or chronic wounds of multiple etiologies. Among the 172 participants treated with PRF in wounds of varying etiologies and different segment times, 130 presented favorable events with the use of the intervention. Among the 10 studies included, only two of them did not demonstrate better results than the control group. The studies showed clinical heterogeneity, making it impossible to perform a meta-analysis. The findings do not provide enough evidence to support the routine use of PRF dressings as the first line of treatment for the healing of acute or chronic wounds of different etiologies. There was great variability in the application of the various protocols and the ways to prepare the PRF, resulting in clinical heterogeneity. Therefore, it makes it impossible to synthesize and to collect evidence from different types of studies in the meta-analysis, which affects the results and their proper discussion.
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