Use of Platelet-rich Plasma in the Treatment of Recalcitrant Sinus Tracts: A Case Series
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Index: WOUNDS 2011;23(11):322–327
Abstract: Sinus tract formation is common in a wide variety of wounds and can be difficult to manage. Nonsurgical techniques for treating sinus tracts have generally been disappointing, though many nonsurgical options have been explored including dermal matrix injection, platelet-derived growth factors, fibrin sealant, and phenytoin. This case series explores the treatment of nonhealing chronic wound-related sinus tracts with autologous platelet-rich plasma (PRP) in a series of patients in a single center, hospital-based, chronic wound care center. Methods. PRP was prepared using the Harvest SmartPRep procedure. During processing, the blood was separated into two distinct chambers: one containing packed red blood cells, and the other with autologous platelet concentrate and plasma supernatant. The plasma was injected into the entire sinus tract beginning from the base of the tract. Results. Nine of 12 patients healed, and three did not heal and required other interventions (excision and flap repair). All patients, except one, received only one PRP injection. One case of infection that could be directly attributed to the PRP injection was reported. All other patients experienced no pain, discomfort, or signs or symptoms of infection. Conclusion. PRP injection can be a useful technique in cases of straight, relatively short, persistent sinus tracts.
Sinus tract formation is common in a wide variety of wounds.1 Surgical excision of the tract followed by either primary closure or secondary healing is generally considered the treatment of choice. Sinus tract treatment with nonsurgical techniques has been disappointing, though many nonsurgical options have been explored including dermal matrix injection, platelet-derived growth factors, fibrin sealant, and phenytoin.2,3
Fibrin sealant has been used mostly in the perianal region to repair cutaneous sinus tracts, intraoperatively as a hemostatic agent in cardiopulmonary surgery, and as a leakage sealant in colon surgery.4,5 Its use has not been reported for chronic wounds. It is somewhat difficult to apply since it seals quickly, which is not ideal for deep, chronic wound repair. Since it is derived from multiple blood donors, there is a risk of viral and other infectious transmission. Additionally, it is relatively expensive and not reimbursed for wound applications. However, based on the use of fibrin sealant in nonhealing gastrointestinal fistulous and sinus tracts, autologous platelet-rich plasma (PRP) was applied as an alternative, thus combining the known sealant properties of activated fibrin with the added release of growth factors from the platelets and the safety of autologous products. The following case series evaluated the treatment of nonhealing chronic wound-related sinus tracts with autologous PRP in a series of patients in a single center, hospital-based, chronic wound care center.
Patients. All patients were seen in a hospital-based outpatient wound care center and had been receiving various therapies for their wounds and chronic sinus tracts. Wound etiologies, timelines, and products used prior to the PRP are summarized in Table 1.