The efficacy and safety of platelet-rich plasma and adipose-derived stem cells: an update

Phthisical eye and orbital ischemia after cosmetic platelet-rich plasma injection to the forehead

Purpose

To report a case of retrograde embolism of cosmetic injection of platelet-rich plasma (PRP) to the ophthalmic artery, resulting in orbital ischemia, blindness, and eventual phthisis bulbi.

Observations

A 37-year-old woman presented with two days of vision loss OS beginning seconds after undergoing cosmetic PRP filler injections to the face at an outside clinic. Immediately after injection to the left medial forehead, the patient reported bleeding, transient loss of consciousness, and complete vision loss OS. Two days later, vision remained no light perception OS and she exhibited manifestations of both anterior and posterior segment ischemia in the left eye. These findings were ultimately attributed to retrograde embolism to the ophthalmic artery via inadvertent injection of PRP into the supratrochlear or supraorbital arteries. She ultimately did not regain her vision in the left eye and the eye became enophthalmic and phthisical.

Conclusions

After conducting a literature review on August 18, 2023, utilizing PubMed and Google Scholar, and searching for the key words "platelet-rich plasma" and "vision loss" or "vision impairment," we did not find any prior reports of anterior segment ischemia or pan-orbital ischemia resulting in phthisis bulbi. In the setting of vision changes after cosmetic platelet-rich plasma filler injection. Additionally, there is no validated therapy for ophthalmic artery occlusion from any cosmetic filler embolism. Further research should prioritize developing therapeutic guidelines for managing such complications. Injectors should also be educated to emergently refer patients to hospitals with ophthalmology consults available and stroke protocols in place.

Autologous platelet rich plasma (A-PRP) combined with pelvic floor muscle training for the treatment of female stress urinary incontinence (SUI): A randomized control clinical trial

IMPORTANCE

Autologous platelet-rich plasma (A-PRP) injection is a novel intervention for stress urinary incontinence (SUI) in women. However, no Phase II clinical trial has compared the outcomes of A-PRP injection combined with pelvic floor muscle training (PFMT) with those of PFMT alone in these women.

OBJECTIVE

The primary aim was to compare the efficacy of A-PRP + PFMT versus PFMT alone in women with SUI. The secondary aim was to determine any adverse effects of A-PRP injection.

DESIGN

Randomized clinical trial, single-blind assessment.

SETTING

Urogynecology clinic at a tertiary medical center.

PARTICIPANTS

Women with previously untreated SUI. Women in whom there was any suspicion of urgency, those with an Overactive Bladder Symptoms Score of ≥1, and those with obesity, pelvic organ prolapse, thrombocytopenia, or coagulopathy were excluded.

INTERVENTIONS

Two injections of A-PRP were administered with a 1-month interval between injections in the A-PRP injection + PFMT group. Both groups received PFMT.

MAIN OUTCOMES AND MEASURES

The primary outcome was determined using the 1-h pad weight test (PWT). Secondary outcomes were measured using the Incontinence Quality of Life Questionnaire, item 11 on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms questionnaire, Patient Global Impression of Improvement, and the percentage subjective improvement score.

RESULTS

Data for 60 study participants were available for analysis (A-PRP + PFMT group, n = 31; PFMT group, n = 29). The 1-h PWT decreased significantly in the A-PRP + PFMT group but only slightly in the PFMT group at the 5-month follow-up. There was a statistically significant between-group difference in the 1-h pad weight of about 8 g in favor of the A-PRP + PFMT group. A statistically significant difference in symptoms of SUI measured by the questionnaires was found between the A-PRP + PFMT group and the PFMT group at the 2- and 5-month follow-up assessments. There were no reports of adverse events following injection of A-PRP.

CONCLUSIONS AND RELEVANCE

A-PRP + PFMT could be a treatment option for women with SUI. Large Phase III randomized controlled trials are required to confirm our findings.

Navigating the Therapeutic Landscape: A Comprehensive Review of Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate in Knee Osteoarthritis

This comprehensive review provides an in-depth analysis of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) as potential treatments for knee osteoarthritis. It explores their mechanisms of action, clinical efficacy, safety considerations, and the importance of personalised treatment approaches. The review highlights promising findings regarding the ability of PRP and BMAC to alleviate symptoms, improve joint function, and potentially slow disease progression. It emphasises the need for further research into long-term outcomes, direct comparative studies, protocol standardisation, biomarker identification, and cost-effectiveness assessments to enhance clinical practice. While the review does not directly compare PRP and BMAC, it provides valuable insights into their respective roles in knee osteoarthritis management. The review aims to contribute to evidence-based advancements in regenerative therapies for knee osteoarthritis by addressing critical research priorities and refining treatment strategies.

The use of platelet-rich plasma in pathologies of the foot and ankle: A comprehensive review of the recent literature

Platelet-rich plasma (PRP) is an autologous serum containing higher concentrations of platelets and growth factors above normal blood. The process of obtaining PRP involves the extraction of blood from the patient which is then centrifuged to obtain a concentrated suspension of platelets. PRP continues to evolve as a potential treatment modality with many applications in orthopaedic surgery. The therapeutic components of PRP possess numerous theoretical regenerative properties. The present manuscript outlines how PRP is prepared, noting the tremendous variability between preparation protocols. Given the growing body of evidence examining the use of PRP in pathologies of the foot and ankle, we assess its efficacy as it relates to our field. Specifically, we evaluate the literature in the past five years regarding the role of PRP in treating plantar fasciitis, Achilles tendinopathy, insertional Achilles tendinitis, Achilles tendon ruptures, osteochondral lesions of the talus, hallux rigidus, and ankle osteoarthritis.

Autologous Shuffling Lipo-Aspirated Fat Combined Mechanical Stretch in Revision Rhinoplasty for Severe Contractures in Asian Patients

BACKGROUND

A severely contracted nose is a common occurrence. Intraoperative expansion is not sufficient to soften the severely constricted nasal envelope, which poses challenges in revision rhinoplasty. In recent years, adjuvant therapies, including nasal fat grafting and cell component injection, are applied before revision rhinoplasty to soften the nasal envelope. Herein, autologous shuffling lipo-aspirated fat and manual mechanical stretch were combined as adjuvant therapy before revision rhinoplasty.

METHODS

A total of 24 patients with severe nasal contracture were included in this study. Of these, 8 received autologous shuffling lipo-aspirated fat and manual mechanical stretch before revision rhinoplasty (comprehensive therapy), 8 underwent mechanical stretch and revision rhinoplasty, and 8 patients underwent only revision rhinoplasty. The objective and subjective outcome assessment was processed in the follow-up period of 6 months. Nasal length, nasal tip projection, nasofrontal angle, and nasolabial angle were measured, and potential complications were assessed.

RESULTS

All 24 patients underwent a successful revision rhinoplasty. In the comprehensive therapy group, no patient had postoperative wound infection and defect of the nasal column mucous. The comprehensive treatment group had the most significant improvement in nasal length and nasal tip projection, and the nasolabial angle was the closest to 90°, which indicated the most effective nasal revision and aesthetic contour.

CONCLUSIONS

The adjuvant therapy combines autologous shuffling lipo-aspirated fat and manual mechanical stretch before revision rhinoplasty could effectively improve the surgical outcome and decrease the postoperative complications regarding severe nasal contractures.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Convergence of Biofabrication Technologies and Cell Therapies for Wound Healing

BACKGROUND

Cell therapy holds great promise for cutaneous wound treatment but presents practical and clinical challenges, mainly related to the lack of a supportive and inductive microenvironment for cells after transplantation. Main: This review delineates the challenges and opportunities in cell therapies for acute and chronic wounds and highlights the contribution of biofabricated matrices to skin reconstruction. The complexity of the wound healing process necessitates the development of matrices with properties comparable to the extracellular matrix in the skin for their structure and composition. Over recent years, emerging biofabrication technologies have shown a capacity for creating complex matrices. In cell therapy, multifunctional material-based matrices have benefits in enhancing cell retention and survival, reducing healing time, and preventing infection and cell transplant rejection. Additionally, they can improve the efficacy of cell therapy, owing to their potential to modulate cell behaviors and regulate spatiotemporal patterns of wound healing.

CONCLUSION

The ongoing development of biofabrication technologies promises to deliver material-based matrices that are rich in supportive, phenotype patterning cell niches and are robust enough to provide physical protection for the cells during implantation.

A novel cell-free intrathecal approach with PRP for the treatment of spinal cord multiple sclerosis in cats

Background

Multiple sclerosis (MS) is a progressive autoimmune demyelinating disease of the central nervous system. To date, there is no effective therapy for it. Our study aimed to determine the potential role of platelet-rich plasma (PRP) in the treatment of MS in cats.

Methods

The current study was conducted on 15 adult Persian cats that were divided into three groups: control negative, control positive (ethidium bromide (EB)-treated group), and PRP co-treated group (EB-treated group intrathecally injected with PRP on day 14 post-spinal cord injury). PRP was obtained by centrifuging blood on anticoagulant citrate dextrose and activating it with red and green laser diodes. The Basso–Beattie–Bresnahan (BBB) scores were used to assess the motor function recovery on days 1, 3, 7, 14, 20, and 28 following 14 days from EB injection. Moreover, magnetic resonance imaging (MRI) analysis, histopathological investigations, transmission electron microscopy (TEM) studies, and immunohistochemical analysis were conducted, and the gene expressions of nerve growth factors (NGFs), brain-derived neurotrophic factors (BDNF), and stromal cell-derived factors (SDF) were evaluated.

Results

Our results indicated that PRP had a significant ameliorative effect on the motor function of the hindlimbs as early as day 20 and so on. MRI revealed that the size and intensity of the lesion were significantly reduced in the PRP co-treated group. The histopathological and TEM investigations demonstrated that the PRP co-treated group had a significant improvement in the structure and organization of the white matter, as well as a high remyelination capacity. Furthermore, a significant increase in myelin basic protein and Olig2 immunoreactivity as well as a reduction in Bax and glial fibrillar acidic protein immune markers was observed. NGFs were found to be upregulated by gene expression.

Conclusion

As a result, we concluded that the intrathecal injection of PRP was an effective, safe, and promising method for the treatment of MS.

Novel Approaches in Addressing Ovarian Insufficiency in 2019: Are We There Yet?

Ovarian insufficiency is described as a multifaceted issue typically encountered in the field of assisted reproduction. The three main identified diagnoses of ovarian insufficiency include premature ovarian failure (POF), poor ovarian response (POR), and advanced maternal age (AMA). Patient heterogeneity in the era of individualized medicine drives research forward leading to the emergence of novel approaches. This plethora of innovative treatments in the service of adequately managing ovarian insufficiency is called to undertake the challenge of addressing infertile patients exploring their reproductive options. This review provides an all-inclusive presentation and critical analysis on novel treatments that have not achieved routine clinical practice status yet, but have recently emerged as promising. In light of the lack of randomized controlled trials conveying safety and efficiency, clinicians are left puzzled in addressing the "how" and "for whom" these approaches may be beneficial. From ovarian injection employing platelet-rich plasma (PRP) or stem cells to artificial gametes and ovaries, ovarian transplantation, and mitochondrial replacement therapy, this descriptive review provides insight toward assisting the practitioner in decision making regarding these cutting-edge treatments. Biological mechanisms, invasiveness levels, efficiency, as well as possible complications, the current status along with bioethical concerns are discussed in the context of identifying future optimal treatment.

Platelet-rich plasma for tendinopathy and osteoarthritis: a narrative review

Background

Musculoskeletal disorders include a wide range of degenerative and inflammatory problems, which can affect any part of the muscular and skeletal system. Platelet-rich plasma (PRP) has been a breakthrough in musculoskeletal medicine, especially with its effects to speed up soft tissue, cartilage, and bone healing. It is now thought that stem cells are able to reverse the degenerative process and promote rapid healing. Platelet-rich plasma (PRP) has received special attention in treating tendinopathy and osteoarthritis. This review aims to do a comprehensive review of the scientific evidence for the efficiency of PRP application in tendinopathy and osteoarthritis.

Main body of the abstract

In osteoarthritis treatment, platelet-rich plasma is thought to influence the whole joint environment by increasing chondrocyte proliferation. The injection of autologous PRP into the joint space and surrounding soft tissues delivers a concentrated dose of these growth factors, which accelerate the healing process and reduce pain.

Short conclusion

Many studies report some benefits in regard to pain and functionality, especially in tendinopathy, but further investigations are needed to incorporate PRP into clinical practice and be a common form of therapy for tendinopathy and osteoarthritis. Caution should be applied with any treatment we use in clinical practice, especially with PRP and other forms of injections.

Platelet-Rich Plasma: Evolving Role in Plastic Surgery

BACKGROUND

The use of platelet-rich plasma has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. It has grown to encompass a wide variety of applications within the field of plastic surgery, including its use in combination with microneedling, laser, and fat-grafting procedures.

METHODS

In this article, the authors aim to (1) describe the preparation process of platelet-rich plasma; (2) discuss the proposed science behind platelet-rich plasma with regard to its evolving role in hair restoration and facial rejuvenation; and (3) highlight the recent literature examining its widespread use.

RESULTS

Based on the available literature, there is a therapeutic advantage to the use of platelet-rich plasma as a single treatment modality for alopecia and skin rejuvenation and in combination with laser skin treatment and fat grafting. There is, however, a considerable amount of variability in the processing, preparation, and treatment modalities.

CONCLUSIONS

Despite a lack of standardized protocols for platelet-rich plasma preparation and a scarcity of large-scale studies with long-term follow-up, there is convincing evidence with objective measurement modalities that display positive outcomes after treatment for skin rejuvenation, hair regrowth, wound healing, and fat graft take.

Combination of platelet rich plasma and stromal vascular fraction on the level of vascular endothelial growth factor in rat subjects experiencing deep dermal burn injury

Background

The healing process of burns includes coagulation, inflammation, and remodeling. Vascular endothelial growth factor (VEGF) is involved throughout this healing process. Stem cells from the platelet-rich plasma (PRP) with stromal vascular fraction (SVF) can increase concentrations of growth factors, including VEGF. This is expected to accelerate burn healing. The aim of this study was to determine the effect of a combination of PRP and SVF on VEGF levels in a rats model of deep dermal burn wound healing.

Materials and methods

This is an experimental research study in rats using a post-test control group design with 4 groups: A) control, B) Vaseline, C) topical PRP and SVF, and D) PRP and SVF injection. Burn wounds were induced according to the modified Guo method.

Results

In a rats model of deep dermal wound healing, topical Vaseline significantly increased serum VEGF compared to control. Topical application and injection of stem cells also significantly increased serum VEGF compared to control and Vaseline. The VEGF concentration was significantly higher following injection of PRP and SVF, suggesting that the injection route is more effective at increasing VEGF levels compared to the topical application of stem cells.

Conclusion

The combination of PRP and SVF, either by injection or topical application, can increase VEGF levels during the healing process from deep dermal burns.

•

Stem cells can increase concentrations of growth factors.

•

Topical application and injection of stem cells significantly increased serum VEGF compared to control.

•

The VEGF concentration was significantly higher following injection of PRP and SVFs.

•

The injection route of stem cells is more effective at increasing VEGF levels compared to the topical application.

Allogeneic Platelet-Rich Plasma: Is It Safe and Effective for Wound Repair?

BACKGROUND

Platelet-rich plasma (PRP) and its derivatives are an emerging biotechnology whereby concentrated platelets provide damaged tissue with growth factors, cytokines, and other mediators to improve healing outcomes. Although there is strong evidence in the benefits of autologous PRP for both acute and chronic wounds, allogeneic PRP has been studied far less in comparison.

SUMMARY

In this mini-review, we discuss critical steps of allogenic PRP (and its derivatives) preparation. We performed a non-systematic review of the literature to identify animal and human subject studies testing allogenic PRP for wound treatment. We searched OVID Medline and PubMed for articles using the keywords "wound, ulcer, lesion, skin, and cutaneous" and "PRP, or platelet-rich plasma, or platelet-rich fibrin, or PRF, or platelet releasate" and "homologous, allogeneic or allogenic," which were limited to non-review articles and English language. Two studies in animal models and 8 studies in patients were reviewed. There were inconsistencies in preparation methods, treatment regimens, and some lacked a control group in their studies. Despite these variations, none of the studies identified any major side effects or adverse events. The treatment resulted in a reduced time to heal and/or reduced wound size in most cases. Key Messages: In situations where autologous PRP is not available or suitable, allogeneic PRP appears to provide a safe alternative. Its efficacy, however, requires larger-scale studies with appropriate controls. Standardization in PRP preparation and treatment regime are also needed to be able to interpret allogenic PRP efficacy.

Evidence-based indications of platelet-rich plasma therapy

Introduction: Platelet-rich plasma (PRP) is an autologous blood-derived product that contains platelet concentrations at least 2/3 times above the normal level and includes platelet-related growth factors. The concept of PRP began in the 1970s in the field of hematology to treat patients with thrombocytopenia. In the 1980s and 1990s, PRP began to be used in surgical procedures such as maxillofacial surgery and plastic surgery. Since then, PRP had been used in orthopedic procedures, cardiac surgery, sports injuries, plastic surgery, gynecology, urology, and more recently in medical esthetics. Areas covered: This review analyzes the mechanisms of action, current indications, clinical evidence, safety and future directions of PRP in the management of various medical conditions. The literature search methodology included using medical subject headings terms to search in PubMed. Articles used were screened and critically appraised by the coauthors of this review. Expert Opinion: Platelet-rich plasma is a therapeutic option used to treat many medical conditions. PRP could be used alone or in combination with other procedures. The effectiveness and safety of PRP has been demonstrated in many medical scenarios, however there is limited availability of large randomized clinical trials.

Combination of platelet-rich plasma and stromal vascular fraction on the level of transforming growth factor-β in rat subjects experiencing deep dermal burn injury

INTRODUCTION

The combination of stromal vascular fraction (SVF) and platelet-rich plasma (PRP) is effective at increasing the concentration of growth factors including transforming growth factor-β (TGF-β). The increase in this growth factor is expected to accelerate the healing of burns. This study aims to determine the effect of giving a combination of SVFs and PRP on TGF-β levels in the healing process of deep dermal burns.

METHODS

This was an experimental study in 64 rats using a post-test control group design consisting of 1 group of SVFs and PRP combination injection treatment group, 1 group given a topical combination of SVFs and PRP, 1 group given Vaseline, and 1 control group.

RESULTS

There was a significant difference in TGF-β levels between the deep dermal burns group that was given a combination of SVFs and PRP injection and topical, the Vaseline group, and the control group with p-value <0.05.

CONCLUSION

The combination of SVFs and PRP increases the level of TGF-β in the healing process of deep dermal burns.

Platelet-Rich Plasma Enhances Distal Flap Viability and Underlying Vascularity in a Radiated Rotational Flap Rodent Model

Importance: Autologous platelet-rich plasma (PRP) has received widespread attention due to its physiologic healing properties, augmenting the body's natural healing process through platelet activation and release of growth factors. The effects of PRP on radiated tissue have been inadequately studied in vivo. Objective: To determine whether PRP can be used to improve viability of radiated tissue subjected to a clinically meaningful stressor, in this case a rotational skin flap. Design, Setting, Participants: This is a prospective trial using a radiated rat abdominal rotational flap model in the laboratory. Male Sprague-Daley rats were used in this study. Harvested PRP or saline control was injected into rotational flaps immediately after surgery. Progression of necrosis was documented with photo analysis. After 1 week, animals were sacrificed and flap tissue was stained and analyzed for presence of vascular tissue. Intervention: PRP versus control injection into radiated skin tissue. Main Outcomes and Measures: Percentage necrosis of rotational flap and number of vascular channels stained with CD31 present in flap tissue. Results: PRP administration helped rescue the distal flap from necrosis, achieving viability similar to nonradiated controls. Superficial vascularity was similarly increased fivefold in radiated tissue if PRP was given postoperatively, mirroring the vascular density of nonradiated tissue. Conclusions and Relevance: PRP may enhance distal rotational flap viability after radiation, possibly by protecting superficial vessels from tissue necrosis when administered at the time of surgery.

What is the potential use of platelet-rich-plasma (PRP) in cancer treatment? A mini review

Platelet-rich-plasma (PRP) is an autologous human platelet concentrate extracted from plasma. PRP has been investigated in order to be used in many fields, with emphasis on the musculoskeletal field applied to sports injuries, as well as on other medical fields such as cardiac surgery, gynecology, pediatric surgery, urology, ophthalmology and plastic surgery. Cancer treatment is another important field where PRP should be investigated; thus, it is important validating PRP preparation protocols to be used in clinical research. Many protocols should be revised since, overall, most studies do not provide necessary information to allow them to be multiplied or replicated. The current review focuses on several topics about cancer, mainly on innovative studies about PRP use as a feasible therapeutic alternative to treat bladder cancer - a field where it could play a key role. Relevant aspects such as platelets' contribution to immune regulation and the supportive role they play in innate and adaptive immune functions are also addressed. Another important topic reviewed in the current study refers to inflammatory process regulation associated with cancer and thrombosis sites, which indicated that tumor-induced platelet activation could be used as an important therapeutic target in the future. New aspects concerning nitric oxide's ability to restrain platelet adhesion and aggregation in order to slow metastasis progress in cancer patients provide an important advantage in cancer treatment. Finally, the current review has pointed out perspectives and the main concerns about, and possibilities of, PRP use in cancer treatment.

Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials

BACKGROUND

The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases.

METHODS

Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines.

RESULTS

Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA.

CONCLUSION

PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality.

LEVEL OF EVIDENCE

Level 2, systematic review of Level 1 and 2 studies.

Platelet-rich plasma decreases fibroblastic activity and woven bone formation with no significant immunohistochemical effect on long-bone healing: An experimental animal study with radiological outcomes

PURPOSE

This study aimed to analyze the immunohistochemical effect of platelet-rich plasma (PRP) on healing of long-bone fractures in terms of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), the Ki-67 proliferation index, and radiological and histological analyses.

METHODS

Sixteen adult rabbits, whose right femoral diaphysis was fractured and fixed with Kirschner wires, were randomly divided into two groups, control and PRP (groups A and B, respectively). PRP was given to group B at 1 week postoperatively, and all animals were euthanized after 12 weeks. Radiographic evaluations were performed periodically. Cortical callus formation, chondroid and woven bone area percentages, osteoblastic and fibroblastic activities, and mature bone formation were examined. The depths of BMP-2 and VEGF staining were measured. The Ki-67 proliferation index was also calculated.

RESULTS

The mean radiological union score of group B was significantly higher than that of group A. There were also statistically significant differences between groups A and B in terms of cortical callus formation, woven bone area percentage, fibroblast proliferation, and mature bone formation. Group B had significantly more cortical callus and mature bone formation with less woven bone and fibroblast proliferation. Immunohistochemical analysis revealed no statistically significant difference between the groups in terms of BMP-2 and VEGF staining and the Ki-67 index.

CONCLUSIONS

PRP had no effect on BMP-2 or VEGF levels with no increase in the Ki-67 proliferation index, although its application had a positive effect on bone healing by increasing callus and mature bone formation with decreased woven bone and fibroblast proliferation.

Use of platelet-rich plasma for the treatment of prostatic cysts in dogs

Abnormalities of the canine prostate gland, in particular, benign hyperplasia and cysts, are frequent in dogs over 5 years of age. Treatment strategies for dogs with prostatic cysts include ultrasound-guided percutaneous drainage with alcohol sclerotherapy, reduction surgery, and omentalization. The aim of this study was to evaluate the use of platelet-rich plasma (PRP) for the treatment of prostatic cysts in dogs. Ten mixed breed adult male dogs were included in the study. Percutaneous drainage was performed prior to ultrasound-guided PRP injection with a 21G spinal needle. The PRP dose contained half of the solution drained from the cyst. Follow-ups were performed 6, 12, 24, and 60 d after treatment. Ten prostatic cysts were successfully treated with PRP after the ultrasound-guided drainage of the cystic cavities. No side effects were observed during the procedures. After the introduction of PRP, cysts detected by ultrasound appeared hypoechoic. On the sixth day, the hypoechoic appearance was maintained and margins were still identifiable. At 24-day and 60-day follow-ups, cysts were no longer detectable by ultrasound. One of the ten dogs had to be euthanized because of the presence of a malignant mesenchymal neoplasm of the oral cavity (fibroblastic sarcoma) and histological examination of serial sections of the prostate gland was performed. Histologic evaluation 1 year after treatment showed a regression of the cystic lesion injected with PRP. The therapy, which uses PRP injection in combination with ultrasound-guided drainage, can be considered a safe and effective strategy for the treatment of prostatic cysts in dogs.

The Effects of Platelet-Rich Plasma and Adipose-Derived Stem Cells on Neovascularization and Fat Graft Survival

BACKGROUND

Adipose-derived stem cell (ADSCs)-assisted and platelet-rich plasma (PRP)-assisted lipofilling aim to enhance angiogenesis and cell proliferation and are promising techniques for lipofilling. This study aimed to compare the outcomes of ADSCs-assisted and PRP-assisted lipofilling.

METHODS

Adipose tissue and human venous blood were obtained from women with early breast cancer. Human ADSCs were isolated and amplified in vitro. PRP was extracted through double centrifugation. The effect of PRP on ADSCs proliferation was evaluated. In the in vivo study, 1 ml of adipose tissue with saline (control group), PRP (PRP group), or ADSCs (ADSCs group) was injected subcutaneously into the dorsum of nude mice. At 2, 4, 8, and 12 weeks after injection, tissues were assessed for volume retention and ultrasound abnormality. For histological assessment, hematoxylin and eosin staining were performed.

RESULTS

Cytokines in PRP and blood were comparable. Regarding the in vitro assay, PRP significantly improved ADSCs proliferation, and the effect was dose-dependent. Concerning the in vivo study, for each time point, ADSCs-assisted lipofilling showed superior volume maintenance. Similarly, the PRP group showed improved angiogenesis and fat survival, as compared with the control group. The angiogenic effect of PRP was inferior to that of ADSCs at most time points. No significant difference was observed at 12 weeks after lipofilling. Complication rates were comparable between the PRP group and ADSCs group.

CONCLUSIONS

PRP-assisted and ADSCs-assisted lipofilling can significantly improve the cosmetic results of grafted fat. PRP-assisted lipofilling, which is considered convenient and clinically available, is a promising technique to improve neovascularization and fat survival.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Fountain of Youth: A Tale of Parabiosis, Stem Cells, and Rejuvenation

Transfusion (or drinking) of blood or of its components has been thought as a rejuvenation method since ancient times. Parabiosis, the procedure of joining two animals so that they share each others blood circulation, has revitalized the concept of blood as a putative drug. Since 2005, a number of papers have reported the anti-ageing effect of heterochronic parabiosis, which is joining an aged mouse to a young partner. The hallmark of aging is the decline of regenerative properties in most tissues, partially attributed to impaired function of stem and progenitor cells. In the parabiosis experiments, it was elegantly shown that factors derived from the young systemic environment are able to activate molecular signaling pathways in hepatic, muscle or neural stem cells of the old parabiont leading to increased tissue regeneration. Eventually, further studies have brought to identify some soluble factors in part responsible for these rejuvenating effects, including the chemokine CCL11, the growth differentiation factor 11, a member of the TGF-β superfamily, and oxytocin. The question about giving whole blood or specific factors in helping rejuvenation is open, as well as the mechanisms of action of these factors, deserving further studies to be translated into the life of (old) human beings.

[Research progress of adipose-derived stem cells in skin wound healing]

Objective

To review the research progress of adipose-derived stem cells (ADSCs) in skin wound healing.

Methods

The recent experiments and clinical studies on the role of ADSCs in skin wound healing were extensively retrieved and analyzed. Additionally, possible mechanisms and novel application strategies were proposed.

Results

As confirmed by in vitro and in vivo experiments and clinical studies, ADSCs promote skin wound healing mainly by two mechanisms: differentiation to target cells that participate in skin wound healing and cytokines paracrine to promote proliferation and migration of various cell lines that are mandatory to promote skin wound healing. Moreover, scaffold materials and cell sheet technology may further add to the potency of ADSCs in promoting skin wound healing.

Conclusion

Remarkable progress has been made in the application of ADSCs in skin wound healing. Further studies are needed to explore the application methods of ADSCs.

Platelet-rich plasma with keratinocytes and fibroblasts enhance healing of full-thickness wounds

Advances in tissue engineering led to the development of various tissue-engineered skin substitutes (TESS) for the treatment of skin injuries. The majority of the autologous TESS required lengthy and costly cell expansion process to fabricate. In this study, we determine the possibility of using a low density of human skin cells suspended in platelet-rich plasma (PRP)-enriched medium to promote the healing of full-thickness skin wounds. To achieve this, full-thickness wounds of size 1.767 cm² were created at the dorsum part of nude mice and treated with keratinocytes (2 × 10⁴ cells/cm²) and fibroblasts (3 × 10⁴ cells/cm²) suspended in 10% PRP-enriched medium. Wound examination was conducted weekly and the animals were euthanized after 2 weeks. Gross examination showed that re-epithelialization was fastest in the PRP+cells group at both day 7 and 14, followed by the PRP group and NT group receiving no treatment. Only the PRP+cells group achieved complete wound closure by 2 weeks. Epidermal layer was presence in the central region of the wound of the PRP+cells and PRP groups but absence in the NT group. Comparison between the PRP+cells and PRP groups showed that the PRP+cells-treated wound was more mature as indicated by the presence of thinner epidermis with single cell layer thick basal keratinocytes and less cellular dermis. In summary, the combination of low cell density and diluted PRP creates a synergistic effect which expedites the healing of full-thickness wounds. This combination has the potential to be developed as a rapid wound therapy via the direct application of freshly harvested skin cells in diluted PRP.

Correction of Severely Contracted Nose

BACKGROUND

Severely contracted nose is manifested with a tight and hardened nasal envelope. Expansion of the contracted skin is an important first step in correcting these revision cases. The underlying weak lower lateral cartilage makes the tip projection structurally difficult to achieve and maintain without rigid supporting cartilage grafting.

METHODS

A total 59 of patients were treated with isolated adipose-derived stromal cells before revision surgery to soften the nasal envelope. Adipose tissues were digested at 37°C with sterile 0.075% collagenase type 2. The average isolated adipose-derived stromal cell count of each serial injection was 5 × 10 cells (total injection volume, 0.5 ml; 1 × 10 cells/ml). Intraoperatively, the lower lateral cartilage was released from surrounding scar tissue to allow for advancement. Rib cartilage and other autologous grafts were used in reconstruction of the internal framework.

RESULTS

The follow-up period ranged from January of 2009 to April of 2014. The mean follow-up period was 10 months. Fifty-one of 59 patients were satisfied with their results. Eight patients underwent revision surgery for the following: infection (two patients), deviation (one patient), warping (two patients), and cosmetic dissatisfaction (three patients). There were two cases of additional warping, but the patients refused revision surgery. Nine patients required additional adipose-derived stromal cell injections at the tip.

CONCLUSIONS

The combination of isolated fat grafting to soften the nasal skin envelope and rigid tip support results in correction of silicone-induced contracted nose. There were no incidences of recurrent nasal contraction or ischemic injury.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

The regenerative role of adipose-derived stem cells (ADSC) in plastic and reconstructive surgery

The potential use of stem cell-based therapies for the repair and regeneration of various tissues and organs offers a paradigm shift in plastic and reconstructive surgery. The use of either embryonic stem cells (ESC) or induced pluripotent stem cells (iPSC) in clinical situations is limited because of regulations and ethical considerations even though these cells are theoretically highly beneficial. Adult mesenchymal stem cells appear to be an ideal stem cell population for practical regenerative medicine. Among these cells, adipose-derived stem cells (ADSC) have the potential to differentiate the mesenchymal, ectodermal and endodermal lineages and are easy to harvest. Additionally, adipose tissue yields a high number of ADSC per volume of tissue. Based on this background knowledge, the purpose of this review is to summarise and describe the proliferation and differentiation capacities of ADSC together with current preclinical data regarding the use of ADSC as regenerative tools in plastic and reconstructive surgery.

Clinical management of Candida albicans keratomycosis in a bottlenose dolphin (Tursiops truncatus)

OBJECTIVE

Corneal ulceration secondary to trauma commonly affects marine mammals, often with opportunistic secondary bacterial or fungal infections. This report characterizes the combined use of auriculopalpebral and ophthalmic nerve blocks, adipose-derived stem cells, and subconjunctival injections for successful treatment of corneal trauma and infection in dolphins.

ANIMAL STUDIED

An 11-year-old, female bottlenose dolphin (Tursiops truncatus) presented with bilateral diffuse corneal opacities, which progressed to keratomycosis caused by Candida albicans.

PROCEDURE

Aggressive medical management was employed, including the use of subconjunctival injections of adipose-derived stem cells, plasma, topical and oral antifungals and antibiotics, and anti-inflammatory and pain medications. Anesthetic block of the auriculopalpebral and ophthalmic nerves was employed to evaluate the corneas.

CONCLUSION

Subconjunctival injections were employed over 52 days, followed by topical drops for 5 months. At last evaluation, there was no evidence of blepharospasm bilaterally. Only a faint superficial gray corneal opacity remained OS. A temporal paraxial corneal opacity was present OD, with receding inactive vascularization and a small amount of melanosis temporally.

Effect of Platelet Rich Plasma Combined with Chitosan Biodegradable Film on Full-Thickness Wound Healing in Rat Model

OBJECTIVE

To assess the effects of platelet rich plasma (PRP) with chitosan biodegradable film on full thickness wound healing in rat.

METHODS

This was an experimental study being performed in 2015 during a 4-month period. Twenty-four male white Wistar rats were divided into four groups of 12 rats each, randomly: Control group (SHAM) with creation of wounds and no treatment, PRP group with creation of wounds and application of one milliliter PRP, Chitosan group (CHIT) with dressing the wound with chitosan and CHIT/PRP group with application of one mL PRPand dressing the wound with chitosan. The wounds were created by cutting healthy skin.Wound size was measured on 6, 9, 12, 15, 18 and 21 post surgery and was compared between groups.

RESULTS

Reduction in wound area, hydroxyproline contents and biomechanical parametersindicated there was significant difference (p=0.001) between group CHIT/PRP and other groups. Biomechanical testing was performed on day 9 post surgery in incisional model. Quantitative histological studies and mean rank of the qualitative studies demonstrated that there was significant difference (p<0.001) between group CHIT/PRP and other groups.

CONCLUSION

PRP with chitosan have beneficial effects on wounds repair and could be suggested for treating various types of wounds in animals and human being.

The Safety and Efficacy of Cell-Assisted Fat Grafting to Traditional Fat Grafting in the Anterior Mid-Face: An Indirect Assessment by 3D Imaging

BACKGROUND

Numerous methodologies and algorithms have been suggested to enhance fat graft survival, including the usage of stromal vascular fraction (SVF) and platelet-rich plasma (PRP), but no long-term studies are available.

OBJECTIVES

This single-center prospective, case-controlled study investigated the safety and efficacy of combining a modified Baker-designed lateral SMASectomy or plication face lift with simultaneous anterior mid-face grafting into site-specific compartments by (1) conventional Coleman's technique or (2) Yoshimura's cell-assisted lipografting technique.

METHODS

On the voluntary principle, candidates selected one of four techniques for volumization of their mid-face: conventional fat grafting; PRP-assisted fat grafting; SVF-assisted fat grafting; and PRP/SVF- assisted fat grafting. For comparison data, comparable fat volumes, SVF volumes and nucleated cells, and PRP volumes and platelet concentrations were injected into each designated group. Indirect volume retentions were determined by standardized Vectra 3D analyses up to 1 year.

RESULTS

PRP, SVF, and PRP/SVF cell supplementation of processed fat resulted in statistically significant percent mean graft retention over their baseline control at 12 months (p < 0.01). The use of either PRP or SVF alone resulted in almost equal outcomes. Combining cell populations provided no additional advantage over single cellular therapy. Complications were negligible.

CONCLUSIONS

Autologous fat grafting continues to be a viable adjunct in facial aesthetic surgery. With refinements in the entire grafting process and the potential benefits of autologous cell approaches with SVF and PRP, future evidence-based controlled studies under regulatory approval may improve graft survival in a safe and effective manner.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The biomechanical and histological effects of platelet-rich plasma on fracture healing

PURPOSE

Platelet-rich plasma (PRP) includes growth factors and proteins that accelerate and stimulate bone regeneration and tissue recovery. The aim of this study was to evaluate the effects of PRP on fracture healing in terms of biomechanics and histology.

METHODS

Seventy female rats were included in this experimental study. They were divided into three groups: Group I (no PRP, n = 30), Group II (PRP added, n = 30) and Group III (control, n = 10). The left femurs of the rats in Groups I and II were osteotomized and fixed by K-wires. Although no additional intervention was performed on Group I rats, PRP was applied to the fracture sites of Group II rats. The remaining ten rats were used as the control group of the biomechanical test (Group III). In the fourth week, nine femurs from Group I and ten femurs from Group II, and in the ninth week, nine femurs from each group were removed, and bone recovery was assessed histologically according to Modified Lane-Sandhu histological scoring criteria. Three-point bending test was applied to femurs for biomechanical evaluation in the ninth week.

RESULTS

Histological healing was found to be significantly higher in Group II than in Group I (p < 0.05). Furthermore, biomechanical test results showed that healing quantity and bone strength were significantly better in Group II than in Group I (p < 0.05).

CONCLUSION

PRP is a widely studied material in the physiology of fracture healing. The results of this study demonstrated the ameliorative biomechanical effects of PRP on fracture healing, in addition to accelerating the histological union of fractures. In the light of these results, PRP could be a viable alternative to accelerate the healing of fractures, late unions or non-unions.

LEVEL OF EVIDENCE

Prospective comparative study, Level II.

Effects of platelet-rich plasma, adipose-derived stem cells, and stromal vascular fraction on the survival of human transplanted adipose tissue

Traditional adipose tissue transplantation has unpredictable viability and poor absorption rates. Recent studies have reported that treatment with platelet-rich plasma (PRP), adipose-derived stem cells (ASCs), and stromal vascular fraction (SVF) are related to increased survival of grafted adipose tissue. This study was the first simultaneous comparison of graft survival in combination with PRP, ASCs, and SVF. Adipose tissues were mixed with each other, injected subcutaneously into the back of nude mice, and evaluated at 4, 8, and 12 weeks. Human adipocytes were grossly maintained in the ASCs and SVF mixtures. Survival of the adipose tissues with PRP was observed at 4 weeks and with SVF at 8 and 12 weeks. At 12 weeks, volume reduction in the ASCs and SVF mixtures were 36.9% and 32.1%, respectively, which were significantly different from that of the control group without adjuvant treatment, 51.0%. Neovascular structures were rarely observed in any of the groups. Our results suggest that the technique of adding ASCs or SVF to transplanted adipose tissue might be more effective than the conventional grafting method. An autologous adipose tissue graft in combination with ASCs or SVF may potentially contribute to stabilization of engraftment.

Treatment algorithm of complications after filler injection: based on wound healing process

Soft tissue filler injection has been a very common procedure worldwide since filler injection was first introduced for soft tissue augmentation. Currently, filler is used in various medical fields with satisfactory results, but the number of complications is increasing due to the increased use of filler. The complications after filler injection can occur at any time after the procedure, early and delayed, and they range from minor to severe. In this review, based on our experience and previously published other articles, we suggest a treatment algorithm to help wound healing and tissue regeneration and generate good aesthetic results with early treatment in response to the side effects of filler. Familiarity with the treatment of these rare complications is essential for achieving the best possible outcome.

Problems associated with alloplastic materials in rhinoplasty

PURPOSE

Augmentation rhinoplasty using alloplastic materials is a relatively common procedure among Asians. Silicon, expanded polytetrafluoroethylene (Gore-tex®), and porous high density polyethylene (Medpor®) are most frequently used materials. This study was conducted to analyze revisional rhinoplasty cases with alloplastic materials, and to investigate the usage of alloplastic materials and their complications. We also reviewed complications caused by various materials used in plastic surgery while operating rhinoplasty.

MATERIALS AND METHODS

We report 581 cases of complications rhinoplasty with alloplastic implants and review of the literature available to offer plastic surgeons an overview on alloplastic implant-related complications.

RESULTS

Among a total 581 revisional rhinoplasty cases reviewed, the alloplastic materials used were silicone implants in 376, Gore-tex® in 183, and Medpor® in 22 cases. Revision cases and complications differed according to each alloplastic implant.

CONCLUSION

Optimal alloplastic implants should be used in nasal structure by taking into account the properties of the materials for the goal of minimizing their complications and revision rates. A thorough understanding of the mechanism involved in alloplastic material interaction and wound healing is the top priority in successfully overcoming alloplastic-related complications.

Injectable tissue-engineered soft tissue for tissue augmentation

Soft tissue augmentation is a process of implanting tissues or materials to treat wrinkles or soft tissue defects in the body. Over the years, various materials have evolved to correct soft tissue defects, including a number of tissues and polymers. Autogenous dermis, autogenous fat, autogenous dermis-fat, allogenic dermis, synthetic implants, and fillers have been widely accepted for soft tissue augmentations. Tissue engineering technology has also been introduced and opened a new venue of opportunities in this field. In particular, a long-lasting filler consisting of hyaluronic acid filler and living human mesenchymal cells called "injectable tissue-engineered soft tissue" has been created and applied clinically, as this strategy has many advantages over conventional methods. Fibroblasts and adipose-derived stromal vascular fraction cells can be clinically used as injectable tissue-engineered soft tissue at present. In this review, information on the soft tissue augmentation method using the injectable tissue-engineered soft tissue is provided.

Stem cell and research in plastic surgery

Regenerative medicine using stem cells has progressed significantly over the last decade. Plastic surgeons historically have used tissues of human being to restore various defect sites and utilized a single cell lines for the tissue regeneration. The cell sources (autologous or allogeneic), cell types (embryonic stem cell or adult stem cell), and source of tissues (bone marrow, muscle, adipose, cartilage, or blood) are very important for stem cell-based tissue coverage. Embryonic stem cells are pluripotent precursors obtained from the inner cell mass of the blastocyst and reported to be used for preventing muscle atrophy after peripheral nerve injury. Multipotent adult stem cells are easily accessed for plastic surgeons during many routine procedures. This article briefly review the current state of overall stem cell research and clinical applications in the plastic surgical field.

Effects of polydeoxyribonucleotide in the treatment of pressure ulcers

This study aimed to examine the positive effects of polydeoxyribonucleotide (PDRN) on the wound-healing process in pressure ulcers. In this randomized controlled trial, the effects of PDRN were compared over time between an experimental group (n=11) and a control group (n=12). The former was administered the same dose of PDRN intramuscularly (1 ampule, 3 mL, 5.625 mg, for 5 days) for 2 weeks and perilesionally (1 ampule, 3 mL, 5.625 mg, twice a week) for 4 weeks. The primary endpoint for determining efficacy was wound healing in the pressure ulcers, which was reflected by the wound surface area determined using VISITRAK Digital (Smith & Nephew, Largo, FL). The secondary endpoint was the pressure ulcer scale for healing score, determined using pressure ulcer scale for healing (PUSH Tool 3.0 developed by the National Pressure Ulcer Advisory Panel). After the 4-week treatment period, PDRN therapy was found to significantly reduce the wound size and PUSH score, without adverse effect during the treatment. The findings indicate that PDRN can positively modify the wound healing process in pressure ulcers, and its use could improve the clinical outcomes of patients and lower the need for additional therapies or hospital stay.

In vivo effects of adipose-derived stem cells in inducing neuronal regeneration in Sprague-Dawley rats undergoing nerve defect bridged with polycaprolactone nanotubes

There have been many attempts for regeneration of peripheral nerve injury. In this study, we examined the in vivo effects of non-differentiated and neuronal differentiated adipose-derived stem cells (ADSCs) in inducing the neuronal regeneration in the Sprague-Dawley (SD) rats undergoing nerve defect bridged with the PCL nanotubes. Then, we performed immunohistochemical and histopathologic examinations, as well as the electromyography, in three groups: the control group (14 sciatic nerves transplanted with the PCL nanotube scaffold), the experimental group I (14 sciatic nerves with the non-differentiated ADSCs at a density of 7×10(5) cells/0.1 mL) and the experimental group II (14 sciatic nerves with the neuronal differentiated ADSCs at 7×10(5) cells/0.1 mL). Six weeks postoperatively, the degree of the neuronal induction and that of immunoreactivity to nestin, MAP-2 and GFAP was significantly higher in the experimental group I and II as compared with the control group. In addition, the nerve conduction velocity (NCV) was significantly higher in the experimental group I and II as compared with the control group (P=0.021 and P=0.020, respectively). On the other hand, there was no significant difference in the NCV between the two experimental groups (P>0.05). Thus, our results will contribute to treating patients with peripheral nerve defects using PCL nanotubes with ADSCs.

Effect of endogenous bone marrow derived stem cells induced by AMD-3100 on expanded ischemic flap

The purpose of this study was to devise an expanded ischemic flap model and to investigate the role of AMD-3100 (Plerixafor, chemokine receptor 4 inhibitor) in this model by confirming its effect on mobilization of stem cells from the bone marrow. Male Sprague-Dawley rats were used as an animal research model. The mobilization of stem cells from the bone marrow was confirmed in the AMD-3100-treated group. The fractions of endothelial progenitor cells (EPC) and the vascular endothelial growth factor receptor (VEGFR) 2+ cells in the peripheral blood were increased in groups treated with AMD-3100. The expression of vascular endothelial growth factor (VEGF) was increased in response to expansion or AMD injection. The expression of stromal cell derived factor (SDF)-1 and VEGFR2 were increased only in unexpanded flap treated with AMD-3100. Treatment with AMD-3100 increased both the number and area of blood vessels. However, there were no statistically significant differences in the survival area or physiologic microcirculation in rats from the other groups. This endogenous neovascularization induced by AMD-3100 may be a result of the increase in both the area and number of vessels, as well as paracrine augmentation of the expression of VEGF and EPCs. However, the presence of a tissue expander under the flap could block the neovascularization between the flap and the recipient regardless of AMD-3100 treatment and expansion.

The effect of platelet-rich plasma on composite graft survival

BACKGROUND

Composite grafts are suitable for facial reconstruction because of good color matching, low donor-site morbidity, acceptable texture, and easy surgical techniques. However, their use is limited to small defects and by unpredictable survival rates. As platelet-rich plasma contains large numbers of growth factors and has been widely used for tissue regeneration, this study aimed to investigate platelet-rich plasma as an adjuvant to enhance composite graft survival.

METHODS

Twenty New Zealand White rabbits were used, and chondrocutaneous composite grafts were applied to their ears. The grafts were then returned to their original positions after rotation to block the original circulation from the base of the graft. Each of the individual ears was assigned randomly into one of two groups: experimental (n=20; platelet-rich plasma group) or control (n=20; control group). The surrounding skin of the composite graft was injected with either 1.0 ml of platelet-rich plasma derived from autologous whole blood in the platelet-rich plasma group or normal saline in the control group. Graft survival, cutaneous blood flow, CD31-stained vessels, and vascular endothelial growth factor protein levels were examined.

RESULTS

Twelve days after surgery, graft viability in the platelet-rich plasma group was higher than in the control group. Blood perfusion was also higher in the platelet-rich plasma group. Compared with the control group, the number of CD31 blood vessels and vascular endothelial growth factor expression levels were significantly increased in the platelet-rich plasma group.

CONCLUSIONS

The authors' results suggest that platelet-rich plasma restores the perfusion of composite grafts by enhancing revascularization and may exert therapeutic effects on the survival of composite grafts.

Platelet-rich plasma and adipose-derived mesenchymal stem cells for regenerative medicine-associated treatments in bottlenose dolphins (Tursiops truncatus)

Dolphins exhibit an extraordinary capacity to heal deep soft tissue injuries. Nevertheless, accelerated wound healing in wild or captive dolphins would minimize infection and other side effects associated with open wounds in marine animals. Here, we propose the use of a biological-based therapy for wound healing in dolphins by the application of platelet-rich plasma (PRP). Blood samples were collected from 9 different dolphins and a specific and simple protocol which concentrates platelets greater than two times that of whole blood was developed. As opposed to a commonly employed human protocol for PRP preparation, a single centrifugation for 3 minutes at 900 rpm resulted in the best condition for the concentration of dolphin platelets. By FACS analysis, dolphin platelets showed reactivity to platelet cell-surface marker CD41. Analysis by electron microscopy revealed that dolphin platelets were larger in size than human platelets. These findings may explain the need to reduce the duration and speed of centrifugation of whole blood from dolphins to obtain a 2-fold increase and maintain proper morphology of the platelets. For the first time, levels of several growth factors from activated dolphin platelets were quantified. Compared to humans, concentrations of PDGF-BB were not different, while TGFβ and VEGF-A were significantly lower in dolphins. Additionally, adipose tissue was obtained from cadaveric dolphins found along the Spanish Mediterranean coast, and adipose-derived mesenchymal stem cells (ASCs) were successfully isolated, amplified, and characterized. When dolphin ASCs were treated with 2.5 or 5% dolphin PRP they exhibited significant increased proliferation and improved phagocytotic activity, indicating that in culture, PRP may improve the regenerative capacity of ASCs. Taken together, we show an effective and well-defined protocol for efficient PRP isolation. This protocol alone or in combination with ASCs, may constitute the basis of a biological treatment for wound-healing and tissue regeneration in dolphins.

Clinical application of adipose stem cells in plastic surgery

Adipose stem cells (ASCs) are a type of adult stem cells that share common characteristics with typical mesenchymal stem cells. In the last decade, ASCs have been shown to be a useful cell resource for tissue regeneration. The major role of regenerative medicine in this century is based on cell therapy in which ASCs hold a key position. Active research on this new type of adult stem cell has been ongoing and these cells now have several clinical applications, including fat grafting, overcoming wound healing difficulties, recovery from local tissue ischemia, and scar remodeling. The application of cultured cells will increase the efficiency of cell therapy. However, the use of cultured stem cells is strictly controlled by government regulation to ensure patient safety. Government regulation is a factor that can limit more versatile clinical application of ASCs. In this review, current clinical applications of ASCs in plastic surgery are introduced. Future stem cell applications in clinical field including culturing and banking of ASCs are also discussed in this review.

Cell therapy for wound healing

In covering wounds, efforts should include utilization of the safest and least invasive methods with goals of achieving optimal functional and cosmetic outcome. The recent development of advanced wound healing technology has triggered the use of cells to improve wound healing conditions. The purpose of this review is to provide information on clinically available cell-based treatment options for healing of acute and chronic wounds. Compared with a variety of conventional methods, such as skin grafts and local flaps, the cell therapy technique is simple, less time-consuming, and reduces the surgical burden for patients in the repair of acute wounds. Cell therapy has also been developed for chronic wound healing. By transplanting cells with an excellent wound healing capacity profile to chronic wounds, in which wound healing cannot be achieved successfully, attempts are made to convert the wound bed into the environment where maximum wound healing can be achieved. Fibroblasts, keratinocytes, adipose-derived stromal vascular fraction cells, bone marrow stem cells, and platelets have been used for wound healing in clinical practice. Some formulations are commercially available. To establish the cell therapy as a standard treatment, however, further research is needed.

Consideration of bone regeneration effect of stem cells: comparison between adipose-derived stem cells and demineralized bone matrix

BACKGROUND

Currently, many studies have sought to address the regeneration of extensive bone defects using stem cells. Here, the authors injected adipose-derived stem cells and demineralized bone matrix (DBM) into areas of bone defect in rabbits and compared their effect on bone regeneration to study the clinical usefulness of stem cells.

METHODS

This study used 20 male New Zealand white rabbits. Four craniectomies were made in 20 male New Zealand white rabbits' calvaria, and 4 different groups of experimental conditions were applied to each of the 4 cranial defects. To the first group, 0.2 mL of DBX, a commercially available clinical preparation ofDBM, was applied with fibrin glue. To the second group, 0.2 mL of adipose-derived stem cells, with confirmed bone differentiation ability, was applied with fibrin glue. To the third group, 0.1 mL of DBX, 0.1 mL of adipose-derived stem cells, and fibrin glue were applied. The fourth group of defects acted as the control and was left unaltered. After 6 weeks, regenerated bone from each defect site in each rabbit was collected and measured for volume change. Bone regeneration was assessed with three-dimensional skull bone computed tomography and histological analysis.

RESULTS

Osteoblasts were confirmed in all defect groups after 6 weeks. Overall, bone regeneration was weakest in the control group, whereas other groups of defects showed distinct bone regeneration. In particular, group 3, to which adipose-derived stem cells and DBM were applied, demonstrated the most active regeneration.

CONCLUSIONS

Both adipose-derived stem cells and DBM demonstrated regeneration effect on cranial defects in rabbits, but it is difficult to conclude which was better, because in each case the amount of regenerated bone was within the margin of error. However, as the most active bone regeneration was observed when both adipose-derived stem cells and DBM were applied together, this combination could be helpful in the correction of extensive bone defects.