Case 1
A 53-year-old woman underwent a transperitoneal left renal cyst decompression operation. During the procedure, an electrical leakage of the metal plate electrode burnt the skin above the left medial malleolus and resulted in a necrosis with a diameter of 4 cm. Despite immediate oral antibiotic (cephalosporins) and regular dressing treatments, the wound gradually became larger and deeper and bony tissue finally became exposed. The wound diameter increased to 6 cm 1.5 months later (Figure 1). While she was receiving regular dressing treatments, a culture for Staphylococcus aureus returned positive. Fifty days later, the patient was admitted to our department and PRP therapy was initiated.
PRP preparation was performed in a sterile environment. Thirty milliliters of whole blood was drawn from the elbow vein. The syringe had been anticoagulated with acid citrate dextrose (ACD) with a ratio of 1:9 to the blood. After a 10-minute centrifugation with a force of 200 g, the blood was then layered into three basic components: red blood cells, platelets, and platelet-poor plasma (PPP). The red blood cell layer was at the lowest level because of different sedimentation coefficients, the platelet layer was in the middle, and the PPP layer was at the top (Figure 2). About four-fifths of the red cells were drawn from the middle tube (Figure 3). The remainder was agitated for several seconds and underwent a second centrifugation at 200 g for 10 minutes. The blood was then centrifuged into two layers; the supernatant was PPP while the lower layer was concentrate platelet (Figure 4). About three-quarters of the supernatant was discarded. The residual PRP (approximately 4 mL) was drawn into a syringe. The platelet concentrate in the PRP was measured to be 6 times the amount found in the baseline count of the whole blood. Another syringe with thrombin and 10% calcium chloride were integrated with the PRP syringe in order to inject PRP and thrombin simultaneously (Figure 5). After clearing the wound, PRP with thrombin/calcium chloride were applied to the ulcer (Figure 6). When PRP was sprayed onto the wound it transformed into a gel. A transparent membrane was used to cover the wound.
On the second day, after the first PRP application, the patient reported pain relief. Over the following 3 weeks and two PRP treatments later, the wound became smaller and granulation tissue grew intensively. The membrane was removed 2 weeks later and the wounds size had decreased significantly (Figure 7). A total of three applications of PRP were performed on this patient within 7 weeks before the wound healed completely (Figures 8, 9).
Case 2
A 41-year-old man fell from a 4-meter height 15 months earlier, which resulted in a second lumbar vertebrae fracture and paraplegia of the lower body. Seven months later, a decubital ulcer was noticed at the inferior surface of the right great trochanter of the femur. After regular wound dressing treatments and approximately 10 debridements, the ulcer grew in size and depth, and the amount of effusion increased significantly. When admitted to the authors’ hospital, the ulcer was 8 cm long and 7 cm wide with yellowish, necrotic tissue (Figure 10). The fistula below the wound extended upward to the superior anterior iliac spine and had a large, underlying dead space (Figure 11).
Simple debridement was performed to remove necrotic tissue before the first application of PRP. The same method was used to prepare the PRP. After the first application, the amount of effusion decreased significantly as observed through the transparent membrane. Wound dressing with PRP therapy was performed every 10 to 15 days. During this period of PRP treatment, the necrotic tissue disappeared gradually. At the third week, a considerable amount of granulation tissue was observed (Figure 12). Gradually, the granulation tissue had completely filled the whole underlying space by week 8 (Figures 13, 14). Ten weeks following admission, suturing was performed to aid in wound skin contraction. After 12 weeks, the wound had healed almost completely (Figure 15). Fourteen weeks and 9 PRP applications later, the wound achieved complete healing (Figure 16).
Case 3
A 9-year-old boy injured himself after his left foot rolled into a bicycle wheel. The injury caused a large defect on the soft tissue of the heel in addition to exposed calcaneal bone. Some fractured bone particles were seen in the wound (Figure 17 and Figure 18). Traditional therapies including antibiotics, debridement, and regular dressing changes failed and the condition of the wound deteriorated. After admission to the authors’ hospital, it was also observed that the Achilles tendon was exposed. Previously, a skin flap transfer would have been considered as treatment. Considering the lower survival rate with such a wound, we attempted PRP treatment on this patient (Figure 19). After the first PRP treatment, the patient was told to follow up with the outpatient clinic 2 weeks later. Much to our surprise, at his first visit the wound had almost completely healed with only a minor skin defect remaining (Figure 20). Three days later, the wound was healed and had completely epithelialized (Figure 21).