Acceleration of Full-thickness Wound Healing in Porcine Model by Autologous Platelet Gel

  • Thu, 9/4/08 - 11:52am
  • 0 Comments
  • 6297 reads
Author(s): 
Yuhui Yan, MD, and David L. Larson, MD

Platelets contain many growth factors that have been postulated to play an important role in the wound healing process and re-epithelization. Autologous platelet-rich plasma gel (APG) was developed in the early 1970s as a by-product of multicomponent pheresis. Techniques and equipment have dramatically improved in the last decade. APG contains supraphysiologic amounts of various platelet growth factors. It is produced from platelet concentrate plus thrombin/calcium mixture. APG is a fibrin tissue adhesive with hemostatic and tissue sealing properties, which can be used to improve wound healing and enhance osteogenesis.1
Autologous platelet-rich plasma gel is a viscous coagulum formed when platelet-rich plasma (PRP) is combined with a thrombin solution. Platelet-rich plasma is a rich resource that contains many growth factors. The thrombin solution assists in gel formation and the calcium chloride acts to reverse the anticoagulant effect of citrate dextrose solution A (ACD-A). Calcium/thrombin also activates platelets and clotting factors (eg, primary hemostasis, serotonin, ADP, thromboxane A).
For 30 years, APG has been used in many clinical areas including cardiovascular surgery, chronic nonhealing wounds, the closure of dural tears, various orthopedic applications (eg, spinal fusions, nonunionizing fractures and total joint replacements), oral surgery, and various plastic surgery procedures (eg, face-lifts, laser resurfacing, breast lifts, breast reconstruction, trans-rectus abdominis muscle [TRAM] flaps, and abdominoplasty).
However, controversy over the efficacy of APG is common, with many clinical practitioners still confused as to the real value of this agent. Some are concerned about hypersensitivity to bovine thrombin, which is a crucial component of APG.
Surgeons often face the challenge of full-thickness cutaneous wounds, (eg, in full-thickness skin grafts or full-thickness cutaneous wounds resulting from trauma). A study of accelerating the healing process in such wounds is especially valuable.2,3
To address these issues, a porcine model was used to evaluate if APG can accelerate the healing process of full-thickness cutaneous wounds.

Material and Methods

References: 

1. Henderson JL, Cupp CL, Ross EV, et al. The effects of autologous platelet gel on wound healing. Ear Nose Throat J. 2003;82(8):598–602.
2. Goslen JB. Wound healing for the dermatologic surgeon. J Dermatol Surg Oncol. 1988;14(9):959–972.
3. Kirsner RS, Eaglstein WH. The wound healing process. Dermatol Clin. 1993;11(4):629–640.
4. Rigal C, Pieraggi MT, Vincent C, Prost C, Bouisou H, Serre G. Healing of full-thickness cutaneous wounds in the pig. I. Immunohistochemical study of epidermo-dermal junction regeneration. J Invest Dermatol. 1991;96(5):777–785.
5. Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Rep Regen. 1994;2(3):165–170.
6. Stiernberg J, Norfleet AM, Redin WR, Warner WS, Fritz RR, Carney DH. Acceleration of full-thickness wound healing in normal rats by the synthetic thrombin peptide, TP508. Wound Rep Regen. 2000;8(3):204–215.
7. O’Kane S, Ferguson MW. Transforming growth factor beta s and wound healing. Int J Biochem Cell Biol. 1997;29(1):63–78
8. Yao F, Visovatti S, Johnson CS, et al. Age and growth factors in porcine full-thickness wound healing. Wound Rep Regen. 2001;9(5):371–377.
9. Sullivan TP, Eaglstein WH, Davis SC, Mertz P. The pig as a model for human wound healing. Wound Rep Regen. 2001;9(2):66–76.
10. Man D, Plosker H, Winland-Brown JE. The use of autologous platelet-rich plasma (platelet gel) and autologous platelet poor plasma (fibrin glue) in cosmetic surgery. Plast Reconstr Surg. 2001;107(1):229–237.

image description image description