Use of platelet concentrate gel in second-intention wound healing: a case report

Autologous blood products: Leucocyte and Platelets Rich Fibrin (L-PRF) and Platelets Rich Plasma (PRP) gel to promote cutaneous ulcer healing - a systematic review

OBJECTIVE

To summarise evidence on the effectiveness of Platelet-Rich Plasma (PRP) gel and Leucocyte and Platelet Rich Fibrin (L-PRF) gel as agents promoting ulcer healing compared with the standard wound dressing techniques alone.

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Individual patient randomised controlled trials on skin ulcers of all types excluding traumatic lesions.Intervention group: treatment with topical application of L-PRF gel or PRP gel to the wound surface.

CONTROL GROUP

treatment with standard skin ulcer care using normal saline, normgel or hydrogel dressings.

INFORMATION SOURCES

Medline (Ovid), Excerpta Medica Database (EMBASE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science and manual search of studies from previous systematic reviews and meta-analyses. The papers published from 1946 to 2022 with no restriction on geography and language were included. The last date of the search was performed on 29 August 2022.

DATA EXTRACTION AND SYNTHESIS

Independent reviewers identified eligible studies, extracted data, assessed risk of bias using V.2 of the Cochrane risk-of-bias tool for randomised trials tool and assessed certainty of evidence by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

MAIN OUTCOME MEASURES

Time to complete healing, proportion healed at a given time and rate of healing.

RESULTS

Seven studies met the inclusion criteria, five using PRP gel and two using L-PRF gel. One study showed a better proportion of complete healing, three reported reduced meantime to complete healing and five showed improved rate of healing per unit of time in the intervention group. The risk of bias was high across all studies with one exception and the GRADE showed very low certainty of evidence.

CONCLUSION

The findings show potential for better outcomes in the intervention; however, the evidence remains inconclusive highlighting a large research gap in ulcer treatment and warrant better-designed clinical trials.

PROSPERO REGISTRATION NUMBER

CRD42022352418.

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.

The efficacy of autologous platelet-rich gel and traditional Chinese medicine in diabetic foot treatment: a parallel randomized controlled clinical trial

INTRODUCTION

Diabetic Foot (DF) is a prevalent metabolic infection. DF wounds are the basis for all cases of non-traumatic lower limbs amputations in diabetes. DF care approaches include debridement of wound, pressure relief in the wounded area, proper wound, infection and ischemia management. However, there is a need for research to develop more effective therapeutic approaches. This study investigated the effectivity and safety of autologous platelet-rich gel combined with conventional treatment and traditional Chinese medicine (TCM) in diabetic foot ulcers therapy.

METHODS

Sixty diabetic foot ulcer patients were divided into treatment and control groups of 30 patients each. The treatment group involved a combination of autologous platelet-rich gel, conventional treatment, and TCM. The control group was only treated with a combination of conventional therapy and TCM. Laboratory variables, including platelets, hemoglobin, albumin, and HbA1c, were analyzed and compared between treatment and control groups at baseline and end-point. Healing area, volume, and rates were compared in both groups.

RESULTS

basic patients' data and the wound conditions had no significant difference between treatment and control group. The treatment and control groups cure rates were 93.3% vs. 50%, respectively. The healing rate per two weeks was significantly higher in the treatment than in control group (0.78±0.05 vs. 0.43±0.04). There was no statistically significant difference in the platelets, hemoglobin, albumin, and HbA1c levels in the treatment and control groups.

CONCLUSION

Autologous platelet-rich gel combined with conventional treatment and traditional Chinese medicine (TCM) is effective and safe for diabetic foot ulcers treatment.

Autologous platelet-rich plasma in the treatment of refractory wounds in cutaneous leukocytoclastic vasculitis complicated with hypertension (grade 2 moderate risk): A case report

INTRODUCTION

Cutaneous leukocytoclastic vasculitis is an inflammatory variant of vasculitis with a variety of causes that only affects the skin. Its pathological manifestations include neutrophil infiltration and nuclear fragmentation. Clinically, it is characterised by a pleomorphic rash, including erythema, purpuric skin lesions, reticulocytosis, necrosis and ulceration. Once formed, local ulcerations are very difficult to heal.

CASE PRESENTATION

A 46-year-old female was diagnosed with cutaneous leukocytoclastic vasculitis. The patient's legs exhibited ulcers with a black eschar on the surface. The largest wound was 4.5 × 4.0 cm and the deepest wound was 1.7 × 1.8 × 1.0 cm. The ulcers had been present for 6 months and did not exhibit signs of healing. Treatment was commenced with platelet-rich plasma, and the wounds healed within 1 month.

CONCLUSION

Topical application of autologous platelet-rich plasma gel exerts beneficial effects in cutaneous leukocytoclastic vasculitis with regard to wound size reduction, and it induces granulation tissue formation. Platelet-rich plasma may represent a safe and cost-effective treatment for managing cutaneous wound healing to reduce the length of the recovery period.