The Efficacy of Platelet-rich Plasma Gel and Topical Estradiol Alone or in Combination on Healing of Full-thickness Wounds
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The results were evaluated using one-way ANOVA, and any significant differences were further evaluated using Tukey’s multiple-comparison test. The level of significance was P < 0.05.
Observations during daily wound care. A superficial scab or layer of medication often hid the wounds. Although there was no significant difference in gross appearance during the first week, a film layer was present in the wound bed in PRP gel group and PRP gel + estradiol group on day 14. A yellow-brown scar was observed in the estradiol and sterile saline solution groups.
On day 21, complete coverage of the wounds with granulation tissue and epithelization was visible in some animals in the PRP gel + estradiol-treated wounds (n = 4), whereas wounds in the other two groups were not completely epithelialized. All wounds continued to reduce in size parallel to wound healing.
Exuberated or deficient granulation tissue was not observed in any group.
The extent and nature of wound contraction and scab formation varied considerably. The wounds were significantly contracted in all groups in relation to days (P < 0.01) despite the fact that a significant difference was not determined between groups.
Gross evaluation. A significant decrease in wound area was measured in the PRP gel + estradiol-treated group and PRP gel-treated group when compared with the other two groups on day 7 (P < 0.05, Table 1). The mean unhealed wound area in the PRP gel + estradiol-treated and PRP gel group-treated groups was significantly smaller than in the other two groups on day 7 and 21. The smallest unhealed wound area was observed in PRP gel + estradiol-treated group on day 14 (P < 0.05, Table 1). The mean unhealed wound area in the sterile saline solution group and in the estradiol-treated group on day 7 and 21 was significantly greater than in the other two groups (P < 0.01, Table 1).
The mean percentage of total wound healing in the PRP gel + estradiol-treated group (P < 0.05) was significantly higher than in the other groups on day 7 and 14.
No significant differences were observed between the estradiol-treated-group and the sterile saline solution group regarding total wound healing rates on day 7 nor between the PRP gel-treated group and the estradiol-treated group on day 14 (P > 0.05, Table 1).
At the end of the study (day 21), mean percentage of total wound healing in the PRP gel + estradiol-treated group (100%) and PRP gel-treated (100%) groups was better than the other groups (P < 0.05, Table 1).
Biochemical evaluation. Hydroxyproline levels of all groups are presented in Table 2. Although statistically insignificant, hydroxyproline content was higher in sterile saline solution and PRP gel + estradiol-treated groups compared with other groups on day 7. On day 14, the hydroxyproline level was the highest in PRP gel + estradiol group, but it showed a steady increase in all groups with time and reached approximately the same level on day 21.
Histopathological evaluation. Collagen level, fibrosis, macrophage count, angiogenesis, and epithelization are illustrated after treatment with normal saline, PRP gel, PRP gel + estradiol, and estradiol for the three time periods (Table 3). On day 7, the collagen level was significantly lower in PRP gel + estradiol group (P < 0.05) than in the sterile saline solution group.
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