Treatment of chronic non-healing ulcers using autologous platelet rich plasma: a case series

Platelet-rich plasma treatment for chronic wounds: A case report and literature review

BACKGROUND

Wound healing is a complicated process that can be heavily influenced by patient comorbidities, in some cases leading to a chronic non-healing wound. Evidence presented in the medical literature supporting the clinical use of autologous platelet-rich plasma (PRP) in treatment of such wounds is becoming increasingly compelling. Mechanisms involved include complex interactions between the patient’s thrombocytes, cytokines, and growth factors.

CASE SUMMARY

We present a case of a 72-year-old male patient with a long-standing chronic wound and multiple comorbidities. Over the course of more than 7 months, the patient was unsuccessfully treated with all routinely used measures, including different dressing approaches. Multiple antibiotic regimens were administered for wound infection, with repeated evaluation of microbiological swab results. Finally, after three PRP applications, the wound showed clinical improvement with complete restitution of the epithelial layer of the skin.

CONCLUSION

PRP treatment may be beneficial to reduce healing time in chronic wounds.

Role of Autologous Platelet-Rich Fibrin in Chronic Non-healing Ulcers With Various Etiologies in a Tertiary Care Rehabilitation Centre: A Case Series

Introduction Chronic non-healing ulcers are defined as a discontinuity or break in the integrity of skin that is not healing in a reasonable period of time due to an underlying systemic etiology. Despite using conventional initial treatment and many other available dressing options, such wounds are difficult to completely heal, thus affecting the progress of rehabilitation measures and compromising functional improvement and quality of life. Materials and methods In this case series, platelet-rich fibrin (PRF) was applied to eight wounds from six patients. The patients included had various etiologies (including spinal cord injury, peripheral vascular disease, Guillain-Barré syndrome, and diabetic foot ulcer) with chronic non-healing wounds over different anatomical locations on the body. Pressure ulcer scale for healing (PUSH) score, surface area, and volume of the wounds were evaluated and monitored weekly after PRF dressing. We have applied PRF every week. On average, two PRF dressings were applied, the maximum being three applications. Results The maximum healing rate in terms of PUSH score was observed to be 3.84% per day, and the minimum was 1.19% per day. The maximum healing rate in terms of surface area was observed to be 5.89% per day, and the minimum was 1.78% per day. Three of the wounds showed complete closure. The maximum follow-up period was 10 weeks. The percentage mean Functional Independence Measure (FIM) improvement was calculated to be 15.87% ± 14.04 during the course of hospitalization after PRF application. Conclusion Based on the results, we can conclude that PRF showed accelerated improvement in the healing of chronic non-healing ulcers of various etiologies at different anatomical locations. It has proven to be a safe and effective method, thereby improving their quality of life and functional independence in performing activities of daily living. To our knowledge till date, no other study in a rehabilitation setting has been done on patients having non-healing ulcers due to various etiologies and at different anatomical locations.

Comparison of the therapeutic effect of platelet-rich plasma and injectable platelet-rich fibrin on testicular torsion/detorsion injury in rats

Testicular torsion is a common disorder in males and results in blockage of testicular circulation with subsequent damage of testicular germ cells. The current work aimed to compare the therapeutic effect of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on torsion/detorsion (T/D) injury in rats. Forty mature male Wister rats were arranged into 4 groups; (1) Control, (2) T/D, (3) T/D + PRP, and (4) T/D+ i-PRF. The right testis was twisting 1080° clockwise for 3 h in groups 2, 3 and 4, then 10 μl of PRP or i-PRF was injected intra-testicular 3 h after detorsion in groups 3 and 4, respectively. After 30 days postoperatively, the semen quality and hormonal assay were improved in PRP and i-PRF-treated groups with superiority of i-PRF (P < 0.001). High significance of Catalase, Glutathione Peroxidase (GPx), Superoxide Dismutase, Interleukin-1β (IL-1β), Caspase-3 and Tumor necrosis factor-α (TNF-α) was reported in treated rats with PRP and i-PRF (P < 0.001) with superiority to i-PRF-treated rats (P < 0.001). Testicular histoarchitectures were improved in PRP and i-PRF-treated rats with superiority of i-PRF-treated rats. It was concluded that PRP and i-PRF have regenerative efficacy on testicular damage after induced T/D injury with a superior efficacy of i-PRF.

The Application of Umbilical Cord Blood-derived Platelet Gel for Skin Ulcers Associated With Chronic Graft-Versus-Host Disease in Pediatrics: A Randomized Trial

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative strategy against a variety of malignant and nonmalignant disorders. However, acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively) commonly complicate this approach, culminating in substantial morbidities and mortalities. The integumentary system is the preponderant organ involved in cGVHD, and its response to existing treatments, including well-versed immunosuppressants and novel targeted therapies, is not desirable. Despite the rarity, ulcers of sclerotic skin cGVHD are treatment-refractory and associated with significant morbidities and an exaggerated risk of infectious complications. Platelet-rich plasma (PRP) and its derivatives are endowed with growth factors and proangiogenic molecules and hold regenerative potential. This study aimed to assess the safety and efficacy of the application of platelet gel-containing dressing against ulcerative skin cGVHD in pediatric patients. This randomized trial is conducted at the hematopoietic stem cell transplantation unit of the Children's Medical Center Hospital in Tehran, Iran. Twenty-one pediatric patients (aged between 5 and 15 years) were initially enrolled, and 16 met the inclusion criteria. All cases (4 females) were recipients of allo-HSCT who had been complicated with symmetrically or near-symmetrically ulcerative sclerotic skin cGVHD. Fresh umbilical cord blood (UCB) was obtained from healthy donors and underwent centrifugation using a novel PRP preparation kit in a single-step process. Platelet gel was produced by adding thrombin to the isolated buffy coat layer. Two similar ulcers of each patient were randomized to receive either conventional dressing or platelet gels up to 6 times. At each time point evaluation, ulcer size and its relative reduction compared to the basal size were recorded. Included patients received a total of 80 platelet gel-containing dressings. While the mean sizes of randomized ulcers at the beginning of the study were similar, their differences became significant 15 days after the initiation of intervention (P = .019). In addition, the mean reduction in the ulcers' surface area (in comparison to their baseline values) was significantly higher for the intervention arm at all evaluation points (P = .001 for day 5 and P < .001 for subsequent time points). At the end of the trial, the number of ulcers with a more than 50% reduction in size was 14 (87.5%) in the intervention arm (including 6 completely healed ulcers) versus 1 (6.25%, which was not completely healed) in the control arm (P < .001). None of the patients exhibited any localized or systemic treatment-related adverse events. In this study, using a relatively large number of cases, we showed that UCB-derived platelet gel is a safe, feasible, and effective curative approach for skin ulcers of sclerotic skin cGVHD in pediatric patients. Designing upcoming trials on the efficacy of this therapeutic approach for ocular, mucosal, and acute skin GVHD is prudent. Retrospectively registered at the Iranian Registry of Clinical Trials (registration number IRCT20190101042197N1) on August 24, 2020.

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.

Fixation with multiple K-wires and PRP injection as an effective way to manage heel pad avulsion

The treatment of acute heel pad avulsion differs significantly from managing other soft tissue injuries due to its unique soft tissue structure. This case report outlines a scenario involving a male in his 20s who suffered heel pad avulsion without a calcaneal fracture but with an ipsilateral medial malleolus fracture after a twisting injury to the ankle caused by a road traffic accident. Immediate action was taken within 24 hours of the injury, involving thorough debridement of the wound, fixation to the calcaneum using multiple K-wires, primary suturing and internal fixation of the medial malleolus with two cannulated cancellous screws. Postoperative care included PRP (platelet-rich plasma) injections into the wound twice, removal of K-wires after 6 weeks and allowing walking with full weight bearing after 8 weeks. A year later, the wound had completely healed, and the patient was comfortably walking pain-free with full weight-bearing capabilities.

Efficacy of Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcer

Introduction Diabetic foot complications leading to limb amputations pose a global health concern. Platelet-rich plasma (PRP) gel has emerged as a promising method for ulcer healing, leveraging the growth factors provided by autologous PRP to enhance tissue healing. Therefore, we aimed to assess the frequency of the success of PRP therapy in the treatment of non-healing diabetic foot ulcers. Methods This quasi-experimental study, conducted in Lahore, Pakistan, from April 2021 to October 2022, enrolled 80 eligible individuals with non-responsive diabetic foot ulcers using a consecutive sampling technique. Inclusion criteria involved patients of both genders, aged 45-75 years, with unhealed diabetic foot ulcers, and exclusion criteria considered factors such as recurrent ulcers at the same site, smoking, and immunosuppressive or anticoagulant drug therapy. Baseline demographic details, ulcer measurements using a scale, and AutoCAD (Autodesk, Inc., San Francisco, California, United States)-assisted quantification of ulcer base were recorded. Autologous PRP injections were administered following strict aseptic protocols, with dressing changes and assessments performed at specified intervals over four weeks. Treatment success, defined as >90% healing after four weeks, was the primary outcome. Data analysis utilized IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), employing post-stratification chi-square and t-tests where appropriate for significant differences. Results The mean age of the patients was 60.40 ± 9.72 years, the mean duration of diabetes was 9.48 ± 2.21 years, and the mean ulcer duration was 11.41 ± 1.63 months. The treatment success rate was 63.7%. Age, gender, and disease duration showed no significant impact on treatment success. However, patients with a normal BMI and shorter ulcer duration exhibited a significantly higher success rate (p <0.001 and p = 0.002, respectively). Conclusions This study reaffirms the efficacy of PRP in treating non-healing diabetic foot ulcers, aligning with previous research. Despite a slightly lower success rate compared to literature reports, PRP remains a promising agent for managing diabetic foot ulcers.

Effect of platelet-rich plasma combined with negative pressure wound therapy in treating patients with chronic wounds: A meta-analysis

A meta-analysis was conducted to comprehensively explore the effects of platelet-rich plasma (PRP) combined with negative pressure wound therapy (NPWT) in treating patients with chronic wounds. Computer searches were conducted, from database infection to November 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the use of PRP combined with NPWT technology for treating chronic wounds. Two researchers independently screened the literature, extracted data and conducted quality assessments according to the inclusion and exclusion criteria. Stata 17.0 software was employed for data analysis. Overall, 18 RCTs involving 1294 patients with chronic wounds were included. The analysis revealed that, compared with NPWT alone, the use of PRP combined with NPWT technology significantly improved the healing rate (odds ratios [OR] = 1.92, 95% confidence intervals [CIs]: 1.43-2.58, p < 0.001) and total effective rate (OR = 1.31, 95% CI: 1.23-1.39, p < 0.001), and also significantly shortened the healing time of the wound (standardized mean difference = -2.01, 95% CI: -2.58 to -1.45, p < 0.001). This study indicates that the treatment of chronic wounds with PRP combined with NPWT technology can significantly enhance clinical repair effectiveness and accelerate wound healing, with a high healing rate, and is worth further promotion and practice.

Treatment with Umbilical Cord Blood Platelet Lysate Gel Improves Healing of Diabetic Foot Ulcer

BACKGROUND

This study was conducted to examine the hypothesis that umbilical cord blood platelet lysate (UCB-PL) gel has a significant impact on the healing rate of DFU. Μethods: In this open-labeled, randomized controlled trial, 110 patients were randomized to treatment with UCB-PL gel (UCB-PL group, n = 52) every three days for one month or dressing with normal saline (control group, n = 58). All participants were followed up for 20 weeks post treatment. Ulcer surface area was assessed with the imitoMeasure application at two, four, and six weeks, and two, four and six months. This study's main outcome was the reduction in ulcer size over the six-month study period.

RESULTS

The mean ulcer area at baseline was 4.1 cm2 in the UCB-PL group and 1.7 cm2 in the control group. At six months post treatment, patients on the UCB-PL treatment displayed a significant reduction in ulcer size compared to baseline 0.12 (0-8.16) in contrast to a more modest change in the control group 1.05 (0-24.7). The ulcer area was decreased at the end of the study in 40 patients (97.6%) in the UCB-PL group and 27 (73%) in the control group (Fisher's p = 0.002).

CONCLUSIONS

The application of UCB-PL gel in DFU resulted in a significant reduction in ulcer size compared to regular saline dressing.

Addressing radiotherapy-induced fibrosis: the potential of platelet-rich plasma and infliximab for improved breast cancer management

Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.

The Potential of Autologous Platelet-Rich Plasma Gel for Diabetic Foot Ulcer Care Among Older Adults: A Systematic Review and Meta-Analysis

Introduction

Poorly controlled diabetes mellitus can lead to the development of diabetic foot ulcers (DFU), which is a frequent complication in patients. However, several diabetes management guidelines for older adults do not mention the occurrence of DFUs. Nowadays, Autologous Platelet-Rich Gel (APG) is being used for treating diabetic ulcers. APG is an innovative platelet-derived product with many advantages, such as being low-cost, easy to produce, and readily available materials. Additionally, it does not lead to any rejection reaction.

Objective

This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients.

Methods

Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method.

Results

Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22-1.57, p < 0.0001), shortened the healing time (Mean difference [MD] -16.97 days (95% CI: -32.64 to -1.29; p < 0.00001), shortened the length of hospital stay (MD= -20.11, 95% CI: -38.02, -2.20; p = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02).

Conclusion

APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment.

Efficacy of Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

BACKGROUND

The probiological healing effect of platelet-rich plasma (PRP) during tissue repair has recently gathered much attention. This study aimed to conduct a systematic review and meta-analysis of patients with diabetic foot ulcer (DFU) receiving PRP or conventional treatment to evaluate their efficacy.

METHODS

PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were comprehensively searched by 2 independent reviewers following PRISMA guidelines for the inclusion of randomized controlled trials (RCTs) comparing PRP with conventional treatments for DFUs. The primary measurements of healing rate and healing time, the methodological quality and extracted data were assessed using Review Manager 5.3. Statistical significance was set at P < 0.05.

RESULTS

A total of 10 RCTs involving 550 patients were included in this study, PRP was observed to significantly improve the healing rate (risk ratio [RR] = 1.38, 95% confidence interval [CI] 1.05-1.82, P = 0.02) and shorten the healing time (mean difference [MD] = -23.23, 95% CI -45.97 to -0.49, P = 0.05) of patients with DFU when compared to the conventional treatment.

CONCLUSIONS

Compared to conventional treatment, PRP effectively promoted the healing of patients with DFU by evidently improving the healing rate and healing time.

Medical Management to Treat Chronic Non-healing Ulcers: A Case Series

INTRODUCTION

Chronic non-healing leg ulcers are skin defects below the knee that resist healing for more than six weeks. They cause physical, emotional, and economic burdens to patients and society.

OBJECTIVES

To introduce an innovative medical strategy that targets the chronic inflammation component in non-healing ulcers (NHUs) with rheumatic features and to evaluate its potential effectiveness in achieving complete healing.

METHODS

We employed an empirical medical therapy regimen, which combined medications like deflazacort, colchicine, dapsone, hydroxychloroquine, and azathioprine. We retrospectively selected 25 patients with chronic pedal ulcers who underwent our therapy.

RESULTS

The mean duration of ulcers was 7.84 years, and the time to heal was 5.97 months. Among 25 patients, 19 had atypical ulcers, four had venous ulcers, and two had diabetic neuropathy ulcers. Four patients with venous ulcers additionally underwent endovenous laser ablation.

CONCLUSION

Our medical strategy showed promising results in healing chronic NHUs with rheumatic features without significant steroid-induced adverse effects.

Efficacy of autologous platelet-rich plasma for long-term glucocorticoids caused chronic wound: a case report

The repair of bone explore wounds is one of the difficult problems in plastic and reconstruction surgery. Platelet-rich plasma (PRP) is a safe and efficient therapeutic option for various trauma, including Osteoarticular, musculoskeletal, and Wound injuries. However, the preparation and storage of PRP becomes challenging for patients with poor systemic status and requiring multi-use of PRP. The availability of safe, reliable tissue bank makes it possible. We report a case of a 42-year-old woman patient with a chronic hip wound combined with ischium bone exploration. And the patient who was treated with long-term glucocorticoids for rheumatoid arthritis has been through the experience of extensive conservative management. Thereafter necrosectomy and Vacuum-Assisted Closure (VAC) surgical procedure failed, and a PRP daily injection was performed at the ischial muscle and soft tissue. Neo-muscle appeared around the explored ischium bone after 8 weeks of injection and Complete wound healing was obtained in 3 months.

Comparison between platelet-rich plasma (PRP) and mechanically emulsified fat grafts in management of chronic wounds

BACKGROUND

chronic wounds represent a challenge in treatment, due to diverse pathogenesis, resistance to ordinary treatment complex and lack of direct methods of treatment In this study, the aim is to compare the effect of Platelet -rich plasma (PRP) and mechanically emulsified fat grafts on the outcome of the healing process of chronic wounds.

PATIENTS AND METHODS

In the current study, 30 patients with chronic wounds were divided into two groups (Group I, 15 patients had application of PRP on chronic wounds). Whereas (Group II, 15 patients had application of mechanically emulsified fat on chronic wounds). In both groups assessment of the healing rates and histopathological changes that were determined by observing the parameters of wound healing, including peri-lesional skin quality, observation of the wound size and depth, assessment of the pain indicated by Visual analog scale score.

RESULTS

Patient were followed up for 6 months. Group II showed a better healing rate 64% in comparison to Group I 55%. Wound parameters and pain score were recorded in both groups with no statistically significant difference.

CONCLUSION

Both PRP and mechanically emulsified fat grafts were found to be efficient treatment modalities in management of chronic "non-healing" wounds. But mechanically emulsified fat grafts represent a better treatment method for chronic wounds.

Platelet-rich plasma improves acute and chronic anal fissure, a randomized control trial

Anal fissure is one of the most prevalent diagnosis in patients with anorectal symptoms. Depending on the chronicity, treatment choices vary, from topical and conservative management to operative ones. PRP is a blood-derived product with a three to five-fold platelet count and can be used for restorative purposes. The objective of this study is to assess the therapeutic effect of intralesional PRP in acute and chronic anal fissures and comparing it with the classic topical approach. We included 94 patients with acute and chronic anal fissures and divided them into intervention and control groups. Control patients were treated only with topical compounds, and the intervention group received one dose of intralesional autologous PRP plus the same classic treatment. We assessed patients 2 weeks, 1 month, and 6 months later. The mean pain score in the intervention group was significantly lower than control groups in all visits (p-value <0.001). During the follow-ups, the bleeding rate was significantly lower in the intervention group, so in the sixth month, the bleeding was 4% in the intervention group against 32% of the control (p-value <0.001). The healing rate assessed by examination was 96% in the intervention group against 66% in the control in the sixth month (p-value <0.001). Although there may be no significant difference in healing rate between groups in the acute anal fissure, the PRP group is significantly superior in the chronic setting. We concluded that in anal fissure treatment, PRP plus topical products are significantly superior to alone topical treatment.

The Effects of Tissue Healing Factors in Wound Repair Involving Absorbable Meshes: A Narrative Review

Wound healing is a complex and meticulously orchestrated process involving multiple phases and cellular interactions. This narrative review explores the intricate mechanisms behind wound healing, emphasizing the significance of cellular processes and molecular factors. The phases of wound healing are discussed, focusing on the roles of immune cells, growth factors, and extracellular matrix components. Cellular shape alterations driven by cytoskeletal modulation and the influence of the 'Formin' protein family are highlighted for their impact on wound healing processes. This review delves into the use of absorbable meshes in wound repair, discussing their categories and applications in different surgical scenarios. Interleukins (IL-2 and IL-6), CD31, CD34, platelet rich plasma (PRP), and adipose tissue-derived mesenchymal stem cells (ADSCs) are discussed in their respective roles in wound healing. The interactions between these factors and their potential synergies with absorbable meshes are explored, shedding light on how these combinations might enhance the healing process. Recent advances and challenges in the field are also presented, including insights into mesh integration, biocompatibility, infection prevention, and postoperative complications. This review underscores the importance of patient-specific factors and surgical techniques in optimizing mesh placement and healing outcomes. As wound healing remains a dynamic field, this narrative review provides a comprehensive overview of the current understanding and potential avenues for future research and clinical applications.

Research trends on platelet-rich plasma in the treatment of wounds during 2002-2021: A 20-year bibliometric analysis

Platelet-rich plasma (PRP) has attracted attention because of its potential to accelerate the wound healing process. However, resources for evaluating research trends in the treatment of wounds with PRP were limited. In this study, we aimed to make a bibliometric analysis of the literature related to PRP in the treatment of wounds and explore the research status, hotspots and frontiers in this field in recent 20 years. Studies about PRP treatment for wounds from 2002 to 2021 were retrieved from the Science Citation Index Expanded (SCI-E) of Web of Science (WOS) database. Visualisation softwares such as VOSviewer and SCImago Graphica, and CiteSpace were used to analyse the research trends and features. A total of 1748 studies were identified in the SCI-Expanded from 2002 to 2021. The number of publications on PRP in the treatment of wounds has shown an increasing trend, from 6 (in 2002) to 228 (in 2021). The papers published in the United States have led in times cited (14637) and H-index (63). Though Italy was slightly lower than China in the number of publications, the H-index and average cited (47, 28.45) were higher than that of China (38, 27.01). The strongest keyword was "fibrin" (strength = 13.07), and the longest burst duration keyword was "thrombin" (began in 2002 and ended in 2014). The largest 10 co-citation clusters are as follows: endothelial cell proliferation (#0), regenerative medicine-associated treatment (#1), diabetic wound healing (#2), autologous derived (#3), platelet-rich fibrin (#4), tissue engineering (#5), regenerative potential (#6), clinical randomised trial (#7), histologic observation (#8), and wound bacteria (#9). The United States has made the most outstanding contribution in this field. Chinese researchers need to enhance the quality of publications further. Wound Repair Regen. is the most noteworthy journal. The mechanism of growth factors of PRP, combination therapy, preparation of PRP, and related clinical trials may be topics that need attention.

The Use of Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcers: A Scoping Review

Platelet-rich plasma (PRP) has been recognized as a method of treatment in medicine since the 1980s. It primarily functions by releasing cytokines and growth factors that promote wound healing; these growth-promoting factors released by PRP enact new processes such as angiogenesis, collagen deposition, and tissue formation that can change wound-healing outcomes. Many studies recognize that PRP aids in chronic wound healing, which is advantageous for patients who suffer from chronic diabetic foot ulcers (DFUs). This scoping review aims to examine the literature to identify the efficacy of PRP use in the healing of DFUs. The objective of this study is to explore whether PRP has a beneficial effect on healing completeness and the rate of healing on DFUs. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched randomized-controlled trials involving PRP use in diabetic patients with foot ulcers using PubMed, Medline, CINAHL Complete, and Cochrane Database of Systematic Reviews. We restricted the search to articles published during 2005-2022, full texts in the English language, articles involving patients aged 19 years or older, articles that used PRP specifically on DFUs, articles that included a control group, and articles with human subjects. The initial search yielded 119 articles after removing duplicates. The final analysis for relevance yielded eight articles. In seven of the eight studies, the PRP group showed significant results, with either faster healing, more complete healing, or a larger percentage of healed participants. In the one study that did not give conclusive evidence of accelerated healing with PRP, PRP was used as an adjunct to fat grafting and only used once. Application styles of PRP for treatment were shown to influence the level of healing in patients, with injected PRP appearing to achieve the best results compared to topical PRP application. However, this was not conclusive due to the involvement of several other variables. Two studies additionally found PRP to be useful in healing refractory DFUs, and one study found that PRP use in patients with additional comorbidities was still more effective in healing DFUs than standard wound control. This study used scoping review methodology with randomized-controlled trials to examine the literature regarding PRP use in the healing of DFUs. The evidence suggests that PRP is a useful tool in reducing healing times and improving rates of complete wound healing in DFUs. There is room for further research in the application styles of PRP before conclusive statements can be made on the efficacy of injected versus topical PRP healing, based on the findings in this study. The results of this review provide a baseline for further research on PRP use in patients with diabetes and can be used by physicians and public health experts to guide future treatment options for DFUs.

Assessment of the quality of the healing process in experimentally induced skin lesions treated with autologous platelet concentrate associated or unassociated with allogeneic mesenchymal stem cells: preliminary results in a large animal model

Regenerative medicine for the treatment of skin lesions is an innovative and rapidly developing field that aims to promote wound healing and restore the skin to its original condition before injury. Over the years, different topical treatments have been evaluated to improve skin wound healing and, among them, mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) have shown promising results for this purpose. This study sought to evaluate the quality of the healing process in experimentally induced full-thickness skin lesions treated with PRP associated or unassociated with MSCs in a sheep second intention wound healing model. After having surgically created full-thickness wounds on the back of three sheep, the wound healing process was assessed by performing clinical evaluations, histopathological examinations, and molecular analysis. Treated wounds showed a reduction of inflammation and contraction along with an increased re-epithelialization rate and better maturation of the granulation tissue compared to untreated lesions. In particular, the combined treatment regulated the expression of collagen types I and III resulting in a proper resolution of the granulation tissue contrary to what was observed in untreated wounds; moreover, it led to a better maturation and organization of skin adnexa and collagen fibers in the repaired skin compared to untreated and PRP-treated wounds. Overall, both treatments improved the wound healing process compared to untreated wounds. Wounds treated with PRP and MSCs showed a healing progression that qualitatively resembles a restitutio ad integrum of the repaired skin, showing features typical of a mature healthy dermis.

A Rare Case of Focused Pulling Type of Trichotillomania Presenting as Dermatological Pathomimicry

Nonhealing ulcers are defined as spontaneous or traumatic lesions, unresponsive to initial therapy, or which persist despite appropriate care. Trichotillomania (TTM) is an impulse control disorder, where severe form may cause ulcer and scarring. After extensive research, we could not find any case showing the association of TTM with large-sized factitious ulcer. Hence, we report a rare case of 30 year old female presenting with TTM and large sized factitious ulcer.

Enhancing Wound Healing: A Novel Topical Emulsion Combining CW49 Peptide and Lavender Essential Oil for Accelerated Regeneration and Antibacterial Protection

Wound healing is a complex process involving blood cells, extracellular matrix, and parenchymal cells. Research on biomimetics in amphibian skin has identified the CW49 peptide from Odorrana grahami, which has been demonstrated to promote wound regeneration. Additionally, lavender essential oil exhibits anti-inflammatory and antibacterial activities. Given these considerations, we propose an innovative emulsion that combines the CW49 peptide with lavender oil. This novel formulation could serve as a potent topical treatment, potentially fostering the regeneration of damaged tissues and providing robust antibacterial protection for skin wounds. This study investigates the physicochemical properties, biocompatibility, and in vitro regenerative capacity of the active components and the emulsion. The results show that the emulsion possesses appropriate rheological characteristics for topical application. Both the CW49 peptide and lavender oil exhibit high viability in human keratinocytes, indicating their biocompatibility. The emulsion induces hemolysis and platelet aggregation, an expected behavior for such topical treatments. Furthermore, the lavender-oil emulsion demonstrates antibacterial activity against both Gram-positive and Gram-negative bacterial strains. Finally, the regenerative potential of the emulsion and its active components is confirmed in a 2D wound model using human keratinocytes. In conclusion, the formulated emulsion, which combines the CW49 peptide and lavender oil, shows great promise as a topical treatment for wound healing. Further research is needed to validate these findings in more advanced in vitro models and in vivo settings, potentially leading to improved wound-care management and novel therapeutic options for patients with skin injuries.

Platelet-derived chemokines promote skeletal muscle regeneration by guiding neutrophil recruitment to injured muscles

Skeletal muscle regeneration involves coordinated interactions between different cell types. Injection of platelet-rich plasma is circumstantially considered an aid to muscle repair but whether platelets promote regeneration beyond their role in hemostasis remains unexplored. Here, we find that signaling via platelet-released chemokines is an early event necessary for muscle repair in mice. Platelet depletion reduces the levels of the platelet-secreted neutrophil chemoattractants CXCL5 and CXCL7/PPBP. Consequently, early-phase neutrophil infiltration to injured muscles is impaired whereas later inflammation is exacerbated. Consistent with this model, neutrophil infiltration to injured muscles is compromised in male mice with Cxcl7-knockout platelets. Moreover, neo-angiogenesis and the re-establishment of myofiber size and muscle strength occurs optimally in control mice post-injury but not in Cxcl7ko mice and in neutrophil-depleted mice. Altogether, these findings indicate that platelet-secreted CXCL7 promotes regeneration by recruiting neutrophils to injured muscles, and that this signaling axis could be utilized therapeutically to boost muscle regeneration.

A meta-analysis on the efficacy of vacuum sealing drainage combined with autologous platelet-rich plasma in the treatment of Grade 2 and Grade 3 diabetic foot ulcers

This meta-analysis aims to systemically evaluate the efficacy of vacuum sealing drainage (VSD) combined with autologous platelet-rich plasma (PRP) in the treatment of diabetic foot ulcers (DFU). The China HowNet, China Biomedical Literature, VIP periodical resource integration service platform, Wanfang, Embase, Cochrane Central, and PubMed databases were retrieved using the computer. The retrieval period was up to July 2021. Randomised controlled trials on VSD combined with PRP in the treatment of DFU were collected. Those trials that met the inclusion criteria were included for meta-analysis using RevMan 5.3 software. A total of 13 articles were included. In the trial group, 477 patients with DFU were treated with VSD combined with PRP, while in the control group, 482 patients with DFU were treated with conventional dressings and/or VSD. The meta-analysis showed that, compared with the control group, VSD combined with PRP has significant advantages in shortening healing time (standardised mean difference [SMD] = -0.87, 95% confidence interval [CI]: -1.07 to -0.67, P < .00001), improving ulcer healing rates (odds ratio = 4.01, 95% CI: 2.95 ~ 5.46, P < .00001), and reducing hospital stays (mean difference = -15.29, 95% CI: -16.05 to -14.54, P < .00001), but the differences in dressing change times (SMD = -1.27, 95% CI: -2.71 to 0.17, P = .08) and hospitalisation expenses (SMD = -0.16, 95% CI: -13.40 to 13.07, P = .98) were not statistically significant. VSD combined with autologous PRP has good curative efficacy in the treatment of DFU and is a better treatment option. However, this treatment is limited in patients with platelet dysfunction, thrombocytopenia, leukaemia, and poor general condition.

Physiotherapeutic interventions in the treatment of patients with diabetic foot ulcers: a systematic literature review

BACKGROUND

Diabetic foot ulcers are chronic wounds that are difficult to heal, with a high rate of recurrent hospitalizations. Due to its multifactorial complexity, treatment must be considered as multidisciplinary, with adjuvant therapy required to aid the healing process.

OBJECTIVES

To identify physiotherapeutic interventions for the treatment of diabetic foot ulcers through a systematic literature review.

DATA SOURCES

PubMed, Cochrane Library, SciELO and Web of Science were searched in April 2020.

STUDY SELECTION OR ELIGIBILITY CRITERIA

The inclusion criteria for this review were: randomised controlled trial published in the last 5 years; written in Portuguese, English or Spanish; subjects aged> 18 years with a diagnosis of diabetic foot ulcers; and physiotherapeutic intervention in combination with multidisciplinary wound management. The methodological quality was assessed using the PEDro scale.

RESULTS

Eight studies were included. Physiotherapists can treat diabetic foot ulcers using therapeutic exercises, electrotherapy, manual therapy and assistive technologies. All physiotherapeutic interventions were adjuvant to standard treatment for wounds provided by other health professionals. The main outcomes were wound size and healing time, with highly favourable results obtained for the experimental groups compared with the control groups.

CONCLUSIONS

Therapeutic exercise, electrotherapy, manual therapy and assistive technologies are physiotherapeutic modalities that, when combined with standard treatment, have been shown to be beneficial in the healing of diabetic foot ulcers.

Local autologous platelet rich plasma injection combined with platelet rich fibrin filling as the main treatment for refractory wounds: A case series

Refractory wounds are a major global health problem that not only affects the quality of life, but also causes significant physical, psychological and economic burdens. How to promote wound healing has become the main goal of clinicians. To evaluate the safety and efficacy of local autologous platelet rich plasma (PRP) injection combined with platelet rich fibrin (PRF) filling as the main treatment for refractory wounds. In the study, autologous PRP and PRF were prepared from whole blood. Twelve patients, each having a refractory wound, were included. The wounds were debrided first to remove necrotic and infected tissues, and then were given once or twice local PRP injection combined with PRF filling treatment. The total healing time (the time from admission to wound healing) and the healing time after PRP/PRF combined treatment (the time from PRP treatment to wound healing), as well as the adverse events were recorded. The results showed that the wound duration before the combination treatment was 10.48 ± 3.66 weeks, and the mean area/volume (for sinus or fistula) of the wounds was 8.23 ± 2.67 cm²/9.54 ± 2.13 cm³ (for sinus or fistula). All wounds healed after once or twice PRP/PRF combined treatment. The total healing time was 26.91 ± 8.01 days, and the healing time after the combined treatment was 16.36 ± 7.47 days. No adverse events were reported during the treatment and follow-up period. Our case series demonstrate the safety and synergistic effectiveness of local autologous PRP injection combined with PRF filling as the main treatment for refractory wounds. Platelet concentrates is not only an adjuvant treatment for chronic wounds, but a potential substitute for chronic wounds, especially in sinuses and fistulas.

Platelet-rich Fibrin versus Platelet-rich Plasma: A Study to Assess Efficacy as a Regenerative Medicine Strategy for Chronic Cutaneous Ulcers

Background

The management of nonhealing ulcers has been a major challenge clinically. Current therapies include debridement, offloading, etc., which show a poor response. Newer modalities include stem cells, platelet-derived growth factors, and fibrin glues, which reduce healing time. Platelets play a major role in wound healing through the secretion of growth factors, chemokines, etc. and have been an area of interest as a modality in regenerative medicine.

Aims and Objective

The aim was to study the comparative efficacy of autologous platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) as a regenerative medicine strategy for chronic cutaneous ulcers.

Materials and Methods

Forty-four ulcers of duration greater than six weeks were enrolled for a comparative study comprising two groups, each divided either into group A receiving PRF dressings or group B receiving PRP dressing for six weeks. The ulcer evaluation was performed at baseline, each weekly dressing, and a two-week follow-up.

Results

Primary efficacy was assessed by the percentage reduction in the volume of ulcers and re-epithelization at eight weeks. In total, 95.2% of ulcers in group A and 90.4% of ulcers in group B showed complete re-epithelization. One ulcer in group A and two ulcers in group B developed an infection. The recurrence of the ulcer was seen in four ulcers in the PRF group and three ulcers in the PRP group.

Conclusion

Dressings done with PRF and PRP showed similar efficacy in the percentage reduction in the volume and re-epithelization of chronic cutaneous ulcers. Both dressings were associated with similar complications. PRF and PRP dressings provide a safe, efficacious, and inexpensive regenerative medicine strategy in the healing of chronic cutaneous ulcers.

Guiding stem cells for cutaneous repair

The significance of mesenchymal stem cells (MSCs) for tissue repair and regeneration is widely recognized. The pleiotropic nature of MSCs is demonstrated by their potential for proliferation and differentiation, and paracrine secretions, thereby making them ideal candidates for cell replacement therapy. Tissue resident MSCs are engaged in homeostasis under normal wear and tear. However, stem cell therapy may be applicable if damage cannot be repaired by normal homeostatic mechanisms. The safety of MSCs has been clearly established in clinical trials but their efficacy remains questionable. The efficacy of MSCs depends on several factors, such as their viability, functional status in terms of secretome secretions, and the in-vivo scenario after transplantation. The performance of MSCs is regulated by their micro-environmental conditions and cues. The so-called MSC niche comprises physical, chemical, and biological components, which play key roles in determining the fate of MSCs. MSCs scaled up for transplantation purposes comprise a disorganized mass of cells, which needs to be directed to perform the required function. Thus, MSCs need to be directed toward an expected target activity in human patients. This review focuses on the various methods that can be used to guide stem cells for cutaneous repair.

Use of Autologous Platelet Rich Plasma (A-PRP) for Postpartum Perineal Repair Failure: A Case Report

Perineal wound dehiscence is an uncommon but important postpartum complication. In many cases, it leads to extreme pain and urinary and defecation problems. For up to several weeks, it can interfere with the mother’s daily activity, affecting psychosexual health and body image. The best way to manage perineal wound breakdown (resuturing vs. spontaneous closure) after childbirth remains controversial. A-PRP is the autologous human plasma containing an increased platelet concentration, rich in growth factors, and mediators with hemostatic, anti-inflammatory, and antimicrobial properties. It accelerates the natural healing process. Even though A-PRP is widely used in orthopedics and dermatology, its use in gynecological injuries is limited. We describe here a case of a woman with postpartum perineal dehiscence treated with A-PRP with positive outcomes.

Platelet-rich plasma: a comparative and economical therapy for wound healing and tissue regeneration

Rise in the incidences of chronic degenerative diseases with aging makes wound care a socio-economic burden and unceasingly necessitates a novel, economical, and efficient wound healing treatment. Platelets have a crucial role in hemostasis and thrombosis by modulating distinct mechanistic phases of wound healing, such as promoting and stabilizing the clot. Platelet-rich plasma (PRP) contains a high concentration of platelets than naïve plasma and has an autologous origin with no immunogenic adverse reactions. As a consequence, PRP has gained significant attention as a therapeutic to augment the healing process. Since the past few decades, a robust volume of research and clinical trials have been performed to exploit extensive role of PRP in wound healing/tissue regeneration. Despite these rigorous studies and their application in diversified medical fields, efficacy of PRP-based therapies is continuously questioned owing to the paucity of large samplesizes, controlled clinical trials, and standard protocols. This review systematically delineates the process of wound healing and involvement of platelets in tissue repair mechanisms. Additionally, emphasis is laid on PRP, its preparation methods, handling, classification,application in wound healing, and PRP as regenerative therapeutics combined with biomaterials and mesenchymal stem cells (MSCs).

Effectiveness of Injected Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcer Disease

Objectives

Platelet-rich plasma (PRP) has become quite a popular course of treatment and has tremendous healing properties. Our research question inquired about the effectiveness of injected formula of PRP as the cure for diabetic foot ulcer in comparison to the conventional dressing.

Methodology 

A prospective observational study was conducted at the Department of Diabetes and Endocrinology, Lady Reading Hospital, Peshawar, Pakistan, between July 2020 to January 2021. Patients' data were collected from the department's database after taking approval from the department. In our study, the selected patients were categorized into two equal groups - i.e. 80 cases in each group and were randomized by using randomization allocation software. In group I (study group) patients received PRP (1 ml /1 cm²) around the wound edges and in the base of the ulcer, while group II (control group) patients were treated with conventional dressing. Each patient was inspected for wounds on days 0, 14, 28, 90, and 180 on the basis of Wagner's classification of wounds to assess efficacy. A proforma was used to collect the required data and then utilized electronically for research analysis.

Results

The mean ± SD of age was 54.4±8.56 and 57.7±10.1 years in the injected PRP (study) and conventional dressing (control) groups, respectively. Of the 30 patients, 13 (43.3%) males and 17 (56.7%) females were enrolled in the study group, while 14 (46.7%) males and 16 (53.3%) females were included in the control group. The PRP was found effective in reducing the wound in about 64 (80%) patients, while wound dressing was effective in 37 (46.25%) patients (p<0.0001). In female patients, the wound healing was significantly better in the study group as compared to the control group (p<0.0001). Moreover, in patients aged above 55 years, frequently higher rates of wound reduction were observed in the study group as compared to the control group (p<0.0001). 

Conclusion

The study concluded that injected PRP was significantly better than conventional dressing in the management of diabetic foot ulcer. More clinical trials are necessary to evaluate the effectiveness of injected PRP to validate the current findings.

Innovative Treatment Strategies to Accelerate Wound Healing: Trajectory and Recent Advancements

Wound healing is highly specialized dynamic multiple phase process for the repair of damaged/injured tissues through an intricate mechanism. Any failure in the normal wound healing process results in abnormal scar formation, and chronic state which is more susceptible to infections. Chronic wounds affect patients’ quality of life along with increased morbidity and mortality and are huge financial burden to healthcare systems worldwide, and thus requires specialized biomedical intensive treatment for its management. The clinical assessment and management of chronic wounds remains challenging despite the development of various therapeutic regimens owing to its painstakingly long-term treatment requirement and complex wound healing mechanism. Various conventional approaches such as cell therapy, gene therapy, growth factor delivery, wound dressings, and skin grafts etc., are being utilized for promoting wound healing in different types of wounds. However, all these abovementioned therapies are not satisfactory for all wound types, therefore, there is an urgent demand for the development of competitive therapies. Therefore, there is a pertinent requirement to develop newer and innovative treatment modalities for multipart therapeutic regimens for chronic wounds. Recent developments in advanced wound care technology includes nanotherapeutics, stem cells therapy, bioengineered skin grafts, and 3D bioprinting-based strategies for improving therapeutic outcomes with a focus on skin regeneration with minimal side effects. The main objective of this review is to provide an updated overview of progress in therapeutic options in chronic wounds healing and management over the years using next generation innovative approaches. Herein, we have discussed the skin function and anatomy, wounds and wound healing processes, followed by conventional treatment modalities for wound healing and skin regeneration. Furthermore, various emerging and innovative strategies for promoting quality wound healing such as nanotherapeutics, stem cells therapy, 3D bioprinted skin, extracellular matrix-based approaches, platelet-rich plasma-based approaches, and cold plasma treatment therapy have been discussed with their benefits and shortcomings. Finally, challenges of these innovative strategies are reviewed with a note on future prospects.

Platelet Derivatives and the Immunomodulation of Wound Healing

Besides their primary role in hemostasis, platelets contain a plethora of immunomodulatory molecules that profoundly affect the entire process of wound repair. Therefore, platelet derivatives, such as platelet-rich plasma or platelet lysate, have been widely employed with promising results in the treatment of chronic wounds. Platelet derivatives provide growth factors, cytokines, and chemokines targeting resident and immigrated cells belonging to the innate and adaptive immune system. The recruitment and activation of neutrophils and macrophages is critical for pathogen clearance in the early phase of wound repair. The inflammatory response begins with the release of cytokines, such as TGF-β, aimed at damping excessive inflammation and promoting the regenerative phase of wound healing. Dysregulation of the immune system during the wound healing process leads to persistent inflammation and delayed healing, which ultimately result in chronic wound. In this review, we summarize the role of the different immune cells involved in wound healing, particularly emphasizing the function of platelet and platelet derivatives in orchestrating the immunological response.

Autologous blood patch treatment of patients with hard-to-heal wounds: a prospective cohort study

OBJECTIVE

To describe the effect of autologous blood patch (3CP, Reapplix, Denmark) treatments as a supplement to standard care among patients with hard-to-heal wounds in an outpatient multidisciplinary wound centre (MWC).

METHOD

The 3CP is an autologous leukocyte- and platelet-rich fibrin patch, which is applied directly into the wound bed. Patients with a wound duration >6 weeks and an unsatisfactory outcome following standard care were considered. Weekly administration of the autologous blood patch was carried out and the wound size was measured using a picture-based area calculation program at three timepoints (first contact with the MWC, initiation of the autologous blood patch treatment and at the end of the autologous blood patch treatment). The effect was followed for one year or until healing.

RESULTS

From June 2016 to September 2019, 36 patients were included. The median age was 63.5 years (interquartile range (IQR): 58-70), and 14 patients were female (38.9%) and 22 were male (61.1%). Median wound duration pre-autologous blood patch was 21.5 weeks (IQR: 11.1-50.0) and median treatment time was 3.4 weeks (IQR: 1.6-5.3). Half of the patients (50%, 18/36) healed in <20 weeks, 30.6% (11/36) healed in 20-52 weeks and 19.4% (7/36) did not heal within a year. There was a significant difference between the mean wound area (±standard deviation) at the start of autologous blood patch treatment and the area at the end: 2.85±3.71cm² versus 1.65±2.37cm², respectively (p=0.0017). Treatment was stopped prematurely for 5/36 patients (reasons included wound infection, major amputation, procedure discomfort or withdrawal without reason).

CONCLUSION

Among MWC patients with hard-to-heal wounds not responding to standard care, autologous blood patch treatment as a supplement to standard wound care expedited wound healing.

Chronic Non-Healing Ulcers Associated with Atopic Inflammation: A Case Report

Chronic non-healing ulcers are the undesirable outcome of delayed wound healing influenced by many factors. It can be seen in patients with diabetes, autoimmune conditions and multiple primary skin conditions. But chronic non-healing ulcers secondary to atopic inflammation are rarely reported in the literature. In this study, we reported a case with wounds caused by the wrong tattoo and surgery, activation of atopic inflammation caused delayed wound healing and the formation of chronic non-healing ulcers. The patient’s atopic inflammation was relieved and stabilized with oral cyclosporine and topical application of halometasone cream and subsequently 0.1% tacrolimus cream, and then the chronic non-healing ulcers healed well, without recurrence at a follow-up visit 3 months later.

Content of blood cell components, inflammatory cytokines and growth factors in autologous platelet-rich plasma obtained by various methods

BACKGROUND

The evaluation of the efficacy of platelet-rich plasma (PRP) in clinical practice yields conflicting results and raises numerous controversies. This may be due to different concentrations of biologically active components in PRP obtained with the use of different methods of gravity separation.

AIM

To compare the content, repeatability and correlations between biologically active components in PRP obtained with four different commercial systems.

METHODS

From a whole blood sample of each of 12 healthy male volunteers, 4 PRP samples were prepared using 4 different commercial kits [Arthrex Autologous Conditioned Plasma (ACP), Mini GPS III, Xerthra, Dr. PRP] in accordance with the instructions provided by the manufacturers. A comparative analysis of blood cell components - 13 selected inflammatory cytokines and 7 growth factors - in the obtained PRP samples was performed using the Kruskal-Wallis test by ranks. The repeatability of results in each method was evaluated by the estimation of the coefficient of variation. The Spearman correlation was used to estimate the relationship between blood cell content and cytokines.

RESULTS

Significantly higher concentrations of platelets (PLT), white blood cells (WBC) and red blood cells (RBC) were found in PRP obtained with the use of Mini GPS III than in PRP obtained using other systems. Significant differences in the content of growth factors and cytokines in PRP were found. A positive correlation of the amount of PLT, RBC and WBC with the concentration of most of the growth factors was found but in only three inflammatory cytokines. The obtained correlations between blood cell components and cytokines differed between the systems in terms of statistical significance, which may be due to insufficient sample size. The repeatability of the obtained PLT concentration also varied between protocols with the lowest in Xerthra and the highest in Arthrex ACP.

CONCLUSION

Significant differences in the content of biologically active components and their repeatability were found in PRP obtained by various methods, providing new data for further research.

PRP Versus Standard of Care for Venous leg Ulcers: A Systematic Review and Meta-Analysis of Prospective Comparative Studies

Venous leg ulcers (VLUs) are chronic and recalcitrant lower limb wounds that affect millions of patients annually, severely reducing their quality of life, and causing a significant burden on the health care system. Recently, Platelet rich plasma (PRP) has been used to improve healing of VLUs. This systematic review aimed at evaluating the effectiveness of PRP versus the standard of care commonly used to treat VLUs. Ten prospective studies (8 randomized) met the inclusion criteria comprising 451 patients with 527 VLUs. Results were as follows: a) the weighted Odds Ratio (OR) of the mean healing rate was 2.84 (95% CI = 1.160 to 5.056, I2 = 41.4%, p = 0.0004), b) the mean healed ulcer areas were 79.2 ± 19% for the PRP group and 51.7 ± 36% for the control group (p = 0.007) in favor of the PRP group, and c) the weighted infection OR showed no significant difference between both groups. Additionally, negative correlations were found between healing rate and duration of VLUs and initial size of the ulcers. This meta-analysis demonstrated significant beneficial effects of PRP versus standard of care on healing rate, reduction in surface, and reduction in healing time of VLUs. Infection and other complications were similar to standard of care. Therefore, our analytical data would support the use of PRP as a safe and effective treatment for VLUs.

Role of platelet rich plasma mediated repair and regeneration of cell in early stage of cardiac injury

Platelet-rich plasma (PRP) is a widely accepted treatment approach and has heightened the quality of care among physicians. PRP has been used over the last decade to boost clinical results of plastic therapies, periodontal surgery and intra-bony defects. According to certain research, elevated levels of PRP growth factors that could promote tissue repair and have the potential for PRP to be beneficial in regenerating processes that Maxillofacial and Oral Surgeons, Veterinary Officers, Athletic medicine specialists and Dermatologists have long admired. PRP is an autologous whole blood fraction that has a heavy amount of a variety of growth factors such as epidermal growth factor (EGF), Vascular Endothelial Growth Factor (VEGF), hepatocyte growth factor (HGF), fibroblast growth factors (FGFs), transforming growth factor beta-1 (TGF-b), insulin-like growth factor-I (IGF-I) and platelet-derived growth factor (PDGF) which can facilitate repair and regeneration. Moreover, a clinical trial of PRP in severe angina patients has shown its excellent safety profile. However, PRP is a very complex biological substance with an array of active biomolecules, its functions are yet to be fully clarified. In-addition, there was insufficient work assessing possible cardiovascular tissue benefits from PRP. Thus, it still remains necessary to identify the most clinically important cardiovascular applications and further research in clinical scenario need to be validated.

Accelerated Wound Healing and Keratinocyte Proliferation through PI3K/Akt/pS6 and VEGFR2 Signaling by Topical Use of Pleural Fluid

Impaired wound healing is an ongoing issue that cancer patients undergoing chemotherapy or radiotherapy face. Our previous study regarding lung-cancer-associated pleural fluid (LCPF) demonstrated its propensity to promote endothelial proliferation, migration, and angiogenesis, which are crucial features during cutaneous wound healing. Therefore, the current study aimed to investigate the effect of pleural fluid on cutaneous wound closure in vitro and in vivo using HaCaT keratinocytes and a full-thickness skin wound model, respectively. Both heart-failure-associated pleural fluid (HFPF) and LCPF were sequentially centrifuged and filtered to obtain a cell-free status. Treatment with HFPF and LCPF homogeneously induced HaCaT proliferation with cell cycle progression, migration, and MMP2 upregulation. Western blotting revealed increased PI3K/Akt phosphorylation and VEGFR2/VEGFA expression in HaCaT cells. When treated with the PI3K inhibitor, LCPF-induced keratinocyte proliferation was attenuated with decreased pS6 levels. By applying the VEGFR2 inhibitor, LCPF-induced keratinocyte proliferation was ameliorated by pS6 and MMP2 downregulation. The effect of LCPF-induced cell junction rearrangement was disrupted by co-treatment with a VEGFR2 inhibitor. Compared with a 0.9% saline dressing, LCPF significantly accelerated wound closure and re-epithelization when used as a dressing material in a full-thickness wound model. Histological analysis revealed increased neo-epidermis thickness and dermis collagen synthesis in the LCPF-treated group. Furthermore, LCPF treatment activated basal keratinocytes at the wound edge with the upregulation of Ki-67, VEGFA, and MMP2. Our preliminaries provided the benefit of wet dressing with pleural fluid to improve cutaneous wound closure through enhanced re-epithelization and disclosed future autologous application in cancer wound treatment.

Immune Cells in Cutaneous Wound Healing: A Review of Functional Data from Animal Models

The healing of skin wounds involves the activation and recruitment of various immune cell types, many of which are believed to contribute significantly to different aspects of the repair process. Roles for immune cells have been described in practically all stages of wound healing, including hemostasis, inflammation, proliferation and scar formation/remodeling. Over the last decade, tools to deplete immune cell populations in animal models have become more advanced, leading to a surge in the number of studies examining the function of specific immune cell types in skin repair. In this review, we will summarize what is known about distinct immune cell types in cutaneous wound healing, with an emphasis on data from animal studies in which specific cell types have been targeted.

Comparison effects of platelet-rich plasma on healing of infected and non-infected excision wounds by the modulation of the expression of inflammatory mediators: experimental research

INTRODUCTION

Microbial invasion in soft tissue is believed to cause infectious wounds and increase healthcare costs, anxiety, and distress. The current study was conducted to evaluate the effects of topical use of platelet-rich plasma (PRP) on infected wound-healing process in rats.

METHODS

Following the induction of a circular wound, the animals were divided into three groups, including (1) standard control: infected wounds treated with mupirocin (SDCL), (2) non-infected wounds treated with PRP (PRP), and (3) infected group in which the rats were infected with Staphylococcus epidermidis and Pseudomonas aeruginosa and treated with PRP (INF + PRP). To evaluate the effects of PRP on the wound-healing rate, total bacterial count, histopathological assessment, the serum concentrations of sialic acid, C-reactive protein, haptoglobin, and fibrinogen were assessed. Additionally, IL-1β, IL-6, TNF-α, IL-3, NF-κB, iNOS, PDGF, and EGF mRNA level expressions were assessed employing the qRT-PCR method.

RESULTS

The results indicated that topical application of PRP could significantly decrease total bacterial count, the level of C-reactive protein, and pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) compared to the SDCL group. The administration of PRP also promoted re-epithelization rate by increasing the expression of EGF mRNA level.

CONCLUSION

We could recommend the use of PRP for the treatment of infected wounds owing to its efficiency in decreasing colonization of tissue bacteria, tissue inflammation, and stimulating wound heal-up.

Clinical Studies on Platelet-Rich Plasma Therapy for Chronic Cutaneous Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Significance: Platelet-rich plasma (PRP) may be a potential drug for treatment of chronic refractory ulcers, which increase the risk of systemic infection and local canceration. However, the efficacy and safety of clinical application of PRP are still controversial. Thus, this study was aimed to assess the efficacy and safety of PRP in patients with chronic ulcers. Recent Advances: For this meta-analysis, Cochrane's Library, MEDLINE, EMBASE, PubMed, Web of Science, and CINAHL (Cumulate Index to Nursing and Allied Health Literature) databases were searched. Results were pooled using a random-effects model. The primary outcome was the proportion of completely healed chronic ulcers. Critical Issues: Seventeen randomized controlled trials were included. Compared with the control group, PRP significantly increased the fraction of healed ulcers (pooled risk ratio [RR] = 1.50; 95% confidence interval [CI] = 1.20 to 1.87; I² = 47.8%). In autologous PRP (APRP) and homologous PRP (HPRP) subgroups, there were statistical differences between the control group versus treatment subgroup (pooled RR = 1.30, 95% CI = 1.10 to 1.54, I² = 25.7%; pooled RR = 3.53, 95% CI = 1.94 to 6.43, I² = 0.0%, respectively). In terms of percent of chronic ulcers area healed, there was a statistically significant difference between the PRP-treated group versus the control group (standard mean difference [SMD] = 1.37, 95% CI = 0.91 to 1.82, I² = 22.1%). As for PRP safety, there existed a statistically significant difference between the APRP subgroup and the HPRP subgroup, respectively (pooled RR = 0.58; 95% CI = 0.35 to 0.98; I² = 0.0%) and (pooled RR = 4.12; 95% CI = 1.55 to 10.96; I² = 6.8%). Future Directions: Our findings shows that PRP may be a beneficial treatment of chronic skin ulcers and that APRP may be much safer than HPRP.

Cost-Effectiveness Analysis for the Treatment of Diabetic Foot Ulcer in France: Platelet-Rich Plasma vs Standard of Care

INTRODUCTION

Diabetic chronic foot ulcers (DFU) lead to pain, reduced quality of life and represent a severe economic burden for patients and health systems. The clinical results of PRP effectiveness in the treatment of DFU are promising; on the other hand, the costs associated with treating DFUs with PRP are higher than those using standard therapy. Therefore, this study aims to determine the cost-effectiveness of platelet-rich plasma (PRP) therapy compared to standard therapy from the French healthcare system perspective.

METHODS

A cost-effectiveness analysis (CEA) was performed using a decision Markov model with a cohort of patients with chronic DFU (duration of >3 weeks) with high orthopaedic risk and with ulcers graded 3A according to University of Texas classification. The effectiveness outcomes are reported in terms of quality adjusted life year (QALY). The costs are reported in euro (€) currency evaluated in 2019. A micro-costing approach alongside a clinical study was used to assess resource use. Deterministic sensibility analyses are reported to evaluate the robustness of the results. The analyses were carried out in the French setting.

RESULTS

The incremental cost-effectiveness ratio (ICER) of PRP treatment is -€613/ QALY, which, being lower than zero, indicates the dominance of the PRP therapy. Deterministic and probabilistic sensitivity analysis underlines the main parameter affecting CE results. Lowest number of standard of care weekly medications (from 5 to 3) leads to a €622/QALY while increasing PRP weekly medication (from 1 to 4) has an ICER of €732/QALY.

DISCUSSION

PRP is a cost-effective or even a cost-saving alternative in the French setting. PRP has higher cost for the complete medication, but, in the absence of wound complications, has the potential to involve lower consumption of resources in the form of routine medication over a 1-year time horizon.

MSCs and their exosomes: a rapidly evolving approach in the context of cutaneous wounds therapy

Currently, mesenchymal stem/stromal stem cell (MSC) therapy has become a promising option for accelerating cutaneous wound healing. In vivo reports have outlined the robust competences of MSCs to offer a solid milieu by inhibition of inflammatory reactions, which in turn, enables skin regeneration. Further, due to their great potential to stimulate angiogenesis and also facilitate matrix remodeling, MSCs hold substantial potential as future therapeutic strategies in this context. The MSCs-induced wound healing is thought to mainly rely on the secretion of a myriad of paracrine factors in addition to their direct differentiation to skin-resident cells. Besides, MSCs-derived exosomes as nanoscale and closed membrane vesicles have recently been suggested as an effective and cell-free approach to support skin regeneration, circumventing the concerns respecting direct application of MSCs. The MSCs-derived exosomes comprise molecular components including lipid, proteins, DNA, microRNA, and also mRNA, which target molecular pathways and also biological activities in recipient cells (e.g., endothelial cell, keratinocyte, and fibroblast). The secreted exosome modifies macrophage activation, stimulates angiogenesis, and instigates keratinocytes and dermal fibroblast proliferations as well as migrations concurrently regulate inherent potential of myofibroblast for adjustment of turnover of the ECM. In the present review, we will focus on the recent findings concerning the application of MSCs and their derivative exosome to support wound healing and skin regeneration, with special focus on last decade in vivo reports.

A case series of platelet rich plasma in chronic venous ulcers

INTRODUCTION

Venous ulcers are the most common type of leg wounds (80%) and the main cause is chronic venous insufficiency. Autologous platelet-rich plasma (PRP) is a potential wound healing treatment due to its great variety of growth factors. The aim of this study was to describe in a case series the results of poor-leukocyte PRP (P-PRP) or saline for the treatment of chronic non-healing ulcers of the lower extremity.

METHODS

Eight patients were treated according to the topical therapy: saline solution or P-PRP gel. All patients used double compression stocks and were assisted by a vascular practitioner for up to 12 months or until wound healing. The treatment was performed weekly with cleaning of the affected area, macroscopic evaluation (area measurement and photos) and P-PRP or saline application, and closure with Tegaderm®. Trial Registration: Retrospectively approved by Brazilian Clinical Trials, register number RBR-7zhgb3 (http://www.ensaiosclinicos.gov.br/rg/RBR-7zhgb3/).

RESULTS

All patients showed signs of wound healing with a reduction in wound size and ulcer numbers, but more evident with P-PRP application.

CONCLUSIONS

The results suggested that P-PRP presented a better result when compared to saline solution in the healing process of long clinical course chronic venous ulcers, when associated to compressive stocks and topical care.

Cord Blood Platelet Gel as a Treatment of Occipital Pressure Injuries in Newborns: Report of Two Cases

Background: A Pressure Ulcer (PU) is a severe event and could create discomfort to newborns. In newborns, one of mostly stricken location by PU is occipital area. Recent studies have highlighted that Cord Blood Platelet Gel (CBPG) might be a better alternative compared to traditional treatment. We report two cases of occipital PU treated with CBPG. Case report: Two male infants showing occipital PU were treated with standard local treatment, but no improvement was observed. After parental informed consent was obtained, CBPG application on PU was performed every 48 h. In these two cases of PU, a fast improvement in healing was observed since the first application of CBPG. The PU healed resulted in a scar after 53 and 50 days (Case 1 and Case 2, respectively) from development. No complications or infections were reported. Conclusions: CBPG contains many angiogenetic and growth factors, these characteristics make it indicated in treating soft tissue injuries. It would seem to be safe and an effective treatment of neonatal PUs reducing the time of the healing and the hospitalization and the infectious risks. Further studies are needed to evaluate long term aesthetic and functional results of PU treated with CBPG.

Venous Leg Ulcers: Advanced Therapies and New Technologies

The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. Medical devices, such as a muscle pump activator, or intermittent pneumatic compression device, may be especially useful for specific subgroups of patients suffering from VLUs. Some of the above-mentioned technologies require broader evidence of clinical efficacy and are still considered experimental therapies in dermatology.