Clinical Study of Platelet-Rich Plasma (PRP) for Lower Extremity Venous Ulcers: A Meta-Analysis and Systematic Review

An overview of systematic reviews of clinical studies of platelet-rich plasma for venous ulcers

To evaluate the clinical evidence of platelet-rich plasma (PRP) in the treatment of venous ulcers (VUs). Electronic searches were conducted through the Cochrane Library, Web of Science, Embase and PubMed. AMSTAR-2 was used to assess the methodological quality. The quality of evidence was assessed using the GRADE system. According to AMSTAR-2, the methodological quality of the included reviews was generally inadequate owing to the limitations of entries 2, 4 and 7. Due to bias risk and imprecision, the evidence quality of the outcome measures was inadequate. In conclusion, PRP may have a therapeutic effect on VUs. However, this conclusion must be treated with caution due to methodological flaws of the included systematic reviews and meta-analyses.

The role of orthobiologics in chronic wound healing

Chronic wounds, characterized by prolonged healing processes, pose a significant medical challenge with multifaceted aetiologies, including local and systemic factors. Here, it explores the complex pathogenesis of chronic wounds, emphasizing the disruption in the normal phases of wound healing, particularly the inflammatory phase, leading to an imbalance in extracellular matrix (ECM) dynamics and persistent inflammation. Senescent cell populations further contribute to impaired wound healing in chronic lesions. Traditional medical management focuses on addressing underlying causes, but many chronic wounds resist to conventional treatments, necessitating innovative approaches. Recent attention has turned to autologous orthobiologics, such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and mesenchymal stem cells (MSCs), as potential regenerative interventions. These biologically derived materials, including bone marrow aspirate/concentrate (BMA/BMAC) and adipose tissue-derived stem cells (ADSCs), exhibit promising cytokine content and regenerative potential. MSCs, in particular, have emerged as key players in wound healing, influencing inflammation and promoting tissue regeneration. This paper reviews relevant scientific literature regarding basic science and brings real-world evidence regarding the use of orthobiologics in the treatment of chronic wounds, irrespective of aetiology. The discussion highlights the regenerative properties of PRP, PRF, BMA, BMAC and SVF, showcasing their potential to enhance wound healing. Despite advancements, further research is essential to elucidate the specific roles of each orthobiologic and determine optimal applications for different wound types. The conclusion underscores the evolving landscape in chronic wound management, with a call for more comprehensive studies to refine treatment strategies and maximize the benefits of regenerative medicine.

Efficacy and safety of platelet-rich plasma in the treatment of venous ulcers: A systematic review and meta-analysis of randomized controlled trials

Considering the substantial impact of venous ulcers on quality of life and healthcare systems, this study evaluated the efficacy and safety of platelet-rich plasma (PRP) in comparison to conventional therapy. A systematic review of four databases identified 16 randomized clinical trials, including 20 study groups. PRP significantly enhanced complete ulcer healing, exhibiting an odds ratio (OR) of 5.06 (95% confidence interval [CI]: 2.35-10.89), and increased the percentage of healed ulcer area by a mean difference of 47% (95% CI: 32%-62%). Additionally, PRP shortened the time required for complete healing by an average of 3.25 months (95% CI: -4.06 to -2.43). Although pain reduction was similar in both groups, PRP considerably decreased ulcer recurrence rates (OR = 0.16, 95% CI: 0.05-0.50) without increasing the risks of infection or irritative dermatitis. These results suggest PRP as a viable, safe alternative for venous ulcer treatment, providing significant improvements in healing outcomes.

Healing techniques for split-thickness skin grafts donor sites. Umbrella review

OBJECTIVES

To summarize the existing evidence and provide recommendations for the most effective management of partial-thickness graft donor sites in adults, with the goals of enhancing re-epithelialization, reducing pain, and preventing infection.

METHODOLOGY

Umbrella review. A systematic search was conducted encompassing databases such as Pubmed, CUIDEN, Cochrane Library, CINHAL Plus, SCOPUS, and LILACS. The search targeted systematic reviews published since 2011 that focused on examining the effectiveness of different approaches for the treatment of partial-thickness graft donor sites. Reviews with a low critical appraisal score according to AMSTAR 2 were excluded. The included reviews were evaluated using the SIGN scale to assess the level of evidence and grade the recommendations.

RESULTS

Five systematic reviews with meta-analysis were incorporated in the analysis. Platelet-rich plasma and human amniotic membrane demonstrated statistically significant improvements in re-epithelialization and pain reduction when compared to the control group. Moreover, platelet-rich plasma also exhibited a decrease in wound infection rates. Recombinant human growth hormone was found to expedite the re-epithelialization process.

CONCLUSIONS

Based on the findings, the use of platelet-rich plasma is recommended to enhance re-epithelialization, alleviate pain, and reduce infection in partial-thickness graft donor sites among adults. Application of human amniotic membrane is recommended to accelerate re-epithelialization and alleviate pain, while recombinant human growth hormone is suggested to expedite the overall healing time of these wounds.

PLASMA RICO EM PLAQUETAS NA CICATRIZAÇÃO DE ÚLCERA VENOSA: RELATO DE CASO

Objetivo:Avaliar a evolução da reparação tecidual de úlcera venosa (UV) tratada com plasma rico em plaquetas (PRP). Métodos: Trata-se de relato de caso com aplicação de PRP para tratamento de UV em uma clínica especializada de uma cidade do sul de Minas Gerais. A cada sessão foram coletados 20 mL de sangue distribuídos em quatro tubos com citrato de sódio. O sangue passou por centrifugação para a extração do PRP. O plasma foi aplicado na ferida após a limpeza com água destilada e solução de polihexametileno biguanida. Posteriormente, a lesão foi coberta com gazes impregnada com petrolato e gazes estéreis como cobertura secundária, associado à terapia compressiva elástica. Resultados: Anteriormente à terapia, a úlcera apresentava 1,18 cm² de área. Após quatro semanas de tratamento com PRP, ocorreu a completa cicatrização. Conclusão: O tratamento mostrou-se eficaz e houve 100% de redução de área.

PLATELET-RICH PLASMA IN VENOUS ULCER HEALING: CASE REPORT

Objective:To evaluate the evolution of tissue repair in venous ulcers treated with platelet-rich plasma. Methods: This is a case report with the application of platelet-rich plasma for the treatment of venous ulcers in a specialized clinic in a city in the south of Minas Gerais. At each session, 20 mL of blood was collected and distributed into four tubes with sodium citrate. The blood was centrifuged to extract platelet-rich plasma. Plasma was applied to the wound after cleaning with distilled water and polyhexamethylene biguanide solution. Subsequently, the lesion was covered with gauze impregnated with petrolatum and sterile gauze as a secondary coverage, associated with elastic compression therapy. Results: Prior to therapy, the ulcer had an area of 1.18 cm². After five weeks of treatment with platelet-rich plasma, complete healing has occurred. Conclusion: Tissue repair occurred after five weeks of treatment without any complications.

A regenerative approach to the pharmacological management of hard-to-heal wounds

A wound is considered hard-to-heal when, despite the appropriate clinical analysis and intervention, the wound area reduces by less than a third at four weeks and complete healing fails to occur within 12 weeks. The most prevalent hard-to-heal wounds are associated with underlying metabolic diseases or vascular insufficiency and include arterial, venous, pressure and diabetic foot ulcers. Their common features include an abnormal immune response and extended inflammatory phase, a subdued proliferation phase due to cellular insufficiencies and finally an almost non-existent remodeling phase. Advances in wound care technology, tested in both pre-clinical models and clinical trials, have paved the way for improved treatment options, focused on regeneration. These interventions have been shown to limit the extent of ongoing inflammatory damage, decrease bacterial load, promote angiogenesis and deposition of granulation tissue, and stimulate keratinocyte migration thereby promoting re-epithelialization in these wounds. The current review discusses these hard-to-heal wounds in the context of their underlying pathology and potential of advanced treatment options, which if applied promptly as a standard of care, could reduce morbidity, promote quality of life, and alleviate the burden on a strained health system.