Autologous Platelet-rich Plasma Enhances Healing of Chronic Wounds
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Abstract: Chronic wounds are a frequent problem in developing countries, are often difficult to heal because they lack the necessary growth factors to maintain the healing process, and are frequently complicated by superinfection. Conventional therapies such as dressings, surgical debridement, and even skin grafting cannot provide satisfactory healing since these treatments are not able to provide enough necessary growth factors to modulate the healing process. Platelet-rich plasma (PRP), as a concentrate of platelets, releases a high concentration of multiple growth factors that can modulate healing processes. Furthermore, PRP also contains a high level of leukocytes, which can inhibit infection. PRP has been widely used in many clinical applications. Three patients with large chronic wounds were treated with PRP and achieved good clinical outcomes.
Address correspondence to:
Chang-Qing Zhang, MD
Shanghai Sixth People’s Hospital
600 Yishan Rd.
Shanghai, China
Phone: 86-21-64369181-8121
Email: terrenceyuan@yahoo.com.cn
Platelet-rich plasma (PRP) is a platelet concentrate that has been widely used in a variety of clinical applications. A number of studies show that PRP enhances and accelerates both soft tissue and hard tissue healing.1–3 The effectiveness of PRP is based on its high level of growth factors such as platelet derived growth factor (PDGF), transforming growth factor-β (TGF-β), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and insulin-like growth factor (IGF), etc. These growth factors are important in modulating mesenchymal cell recruitment, proliferation, and extracellular matrix synthesis during the healing process.
Chronic cutaneous wounds are a frequent problem in developing countries and are often difficult to heal because they lack the growth factors necessary for the healing process, and are frequently complicated by superinfection.4 Conventional therapies such as dressings, surgical debridement, and even skin graft cannot provide satisfactory healing since these treatments are not able to provide enough necessary growth factors to modulate the healing process. Patients with chronic ulcers frequently have to undergo long-term dressing regimens and repetitive debridement without a definitive outcome. Some commercial recombinant growth factor products, like becaplermin (recombinant PDGF-BB), is FDA-approved for the treatment of chronic wounds, but its time-release delivery is a significant problem because it is liquid and quickly disappears once it has been applied to the wound. Additionally, the product is expensive and most patients cannot afford such high cost in developing countries. Based on the authors’ clinical experiences, the use of recombinant growth factors may not be an ideal choice in the treatment of refractory ulcers.
PRP contains various growth factors that are necessary in wound healing. Moreover, it also has some other advantages. After blending with calcium and thrombin, PRP turns into gel, which prevents growth factors and leukocytes from releasing, and maintains their activity for a longer time within the wound. Additionally, a high concentration of leukocytes contained in PRP is also helpful in inhibiting infections.5
The preparation of PRP is simple. Only two centrifugations of autologous whole blood and a total of 20 to 30 minutes are required. PRP is biocompatible and safe, and does not carry an infection risk. We applied PRP gel on three patients with large ulcers. All 3 cases had a long history of conventional treatments without definitive results.
Case Reports
Case 1: A 53-year-old woman underwent a transperitoneal left renal cyst decompression operation.
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