The “biological chamber” method – use of autologous platelet-rich plasma (PRP) in the treatment of poorly healing lower-leg ulcers of venous origin
Languages of publication
Wound healing is a complex pathophysiological process, in which platelets play a crucial role. Platelet alpha-granules release growth factors to the wound bed; the factors are necessary in the healing process. In chronic wounds, such as poorly healing lower-leg ulcers of venous origin, there is decreased activity of multiple growth factors, so the concept of exogenous delivery of such factors seems a logical strategy. Platelet-rich plasma therapy in patients with lower-leg ulcers of venous origin combined with conventional treatment methods (previously ineffective in these patients) seems, based on our observation, an important adjunct leading to recovery. The aim of the study was to present an original method of autologous platelet-rich plasma application through the creation of a sort of “biological chamber” containing a concentrate of growth factors. Material and methods. The described therapy was implemented in 10 patients, who had been ineffectively treated for more than one year in the outpatient setting. Patients with exacerbation of inflammatory process, signs of wound infection and ankle brachial pressure index < 0.8 were excluded from the study. After the application of platelet-rich plasma, further treatment was continued with the use of moist therapy and compression therapy according to a uniform regimen. Results. Complete healing was achieved within 4-10 weeks from the beginning of the product administration in all patients. Conclusion. The presented method seems technically simple, effective and relatively inexpensive
1 - 6 - 2015
19 - 5 - 2015
4 - 8 - 2015
- 1. Werner S, Grose R: Regulation of Wound Healing by Growth Factors and Cytokines. Physiol Rev 2003; 83: 835‑70.
- 2. Ross R, Glomset J, Kariyja B et al.: A plateletdependent serum factor that stimulates the proliferation of arterial smooth muscle cells in vitro. Proc Natl Acad Sci USA 1974; 71: 1207‑10.
- 3. Knighton DR, Hunt TK, Thakral KK et al.: Role of platelets and fibrin in the healing sequence - An in vivo study of angiogenesis and collagen synthesis. Annals of Surgery 1982; 196: 379‑88.
- 4. Mehta S, Watson JT: Platelet rich concentrate: basic science and current clinical applications. J Orthop Trauma 2008; 22: 432‑38.
- 5. Waniczek D, Buda K, Rudzki M i wsp.: Własna metoda cyfrowej dokumentacji stanu miejscowego owrzodzeń żylnych podudzi. J Ecol Health 2012; 2: 84‑92.
- 6. Lacci KM, Dardik A: Platelet-rich plasma: support for its use in wound healing. Yale J Biol Med 2010; 83: 1‑9.
- 7. Bielecki TM, Gaździk TS, Arendt J et al.: Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances; an in vitro study. J Bone and Joint Surg 2007; 89-B, 3:417‑20.
- 8. Li GY, Yin JM, Ding H et al.: Efficacy of leukocyte - and platelet rich plasma gel (L-PRP gel) in treating osteomyelitis in a rabbit model. J Orthop Res 2012 Dec 31. doi: 10.1002/jor.22299.
- 9. Everts PA, Brown Mahoney C, Hoffmann JJ et al.: Platelet-rich plasma preparation using three devices: implications for platelet activation and platelet growth factor release. Growth Factor 2006; 24(3): 165‑71.
- 10. Everts PA, Hoffmann J, Weibrich G et al.: Differences in platelet growth factor release and leucocyte kinetics during autologous platelet gel formation. Transfus Med 2006; 16(5): 363‑68.
- 11. Slesaczeck T, Paetzold H, Nanning T et al.: Autologous derived, platelet-rich plasma gel in the treatment of nonhealing diabetic foot ulcer: a case report Ther Adv Endocrinol Metab 2012 April; 3(2): 75‑78. doi: 10.1177/2042018812438213
- 12. Frykberg RG., Driver VR., Carman D et al.: Chronic wounds treated with a physiologically relevant concentration of platelet-rich plasma gel: a prospective case series. Ostomy Wound Manage 2010; 56: 36‑44.
- 13. McAleer JP, Sharma S, Kaplan EM et al.: Use of autologous platelet concentrate in a nonhealing lower extremity wound. Adv Skin Wound Care 2006Sep; 19(7): 354‑63.
- 14. de Leon JM, Driver VR, Fylling CP et al.: The clinical relevance of treating chronic wounds with an enhanced near-physiological concentration of platelet-rich plasma gel. Adv Skin Wound Care 2011 Aug; 24(8): 357‑68. doi: 0.1097/01.ASW.0000403249.85131.6f.
- 15. Anitua E, Andia I, Ardanza B et al.: Autologus platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004; 91: 4‑15.
- 16. Eppley BL, Woodell JE, Higgins J et al. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing.Plast Reconstr Surg 2004; 114(6): 1502‑08.
- 17. Carter MJ, Fylling CP, Parnell LK: Use of platelet rich plasma gel on wound healing: a systematic review and meta-analysis. Eplasty 2011;11: e38.Epub 2011 Sep 15.
- 18. Scimeca, C, Bharara M, Fisher T et al.: Novel Use of Platelet-Rich Plasma to Augment Curative Diabetic Foot Surgery. J Diabetes Sci Technol 2010; 4: 1121‑26.
- 19.Yamaguchi Y, Yoshikawa K: Cutaneus wound healing: an update. Journal of Dermatology 2001; 28: 521‑34.
- 20. Knighton DR, Ciresi KF, Fiegel VD et al.: Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF).Ann Surg 1986; 204(3): 322‑30.
- 21. Krupski WC, Reilly LM, Perez S et al.: A prospective randomized trial of autologous platelet-derived wound healing factors for treatment of chronic nonhealing wounds: a preliminary report. J Vasc Surg 1991; 14(4): 526‑32; discussion 532‑36.
- 22. Waniczek D, Kozowicz A, Muc-Wierzgoń M et al.: Adjunct methods of the standard diabetic foot ulceration therapy. Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine (2013) Article ID 243568, 12 pages.
- 23. Driver VR, Hanft J, Fylling CP: Autologel Diabetic Foot Ulcer Study GroupA prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers.Ostomy Wound Manage 2006 Jun; 52(6): 68‑70, 72, 74 passim.
- 24. Margolis DJ, Kantor J, Santanna J et al.: Effectiveness of platelet releasate for the treatment of diabetic neuropathic foot ulcers. Diabetes Care 2001 Mar; 24(3): 483‑88.
- 25. Saldalamacchia G, Lapice E, Cuomo V et al.: A controlled study of the use of autologous platelet gel for the treatment of diabetic foot ulcers. Nutr Metab Cardiovasc Dis 2004 Dec; 14(6): 395‑96.
- 26. Villela DL, Santos VL: Evidence on the use of platelet-rich plasma for diabetic ulcer: a systematic review. Growth Factors. 2010 Apr; 28(2): 111‑16. doi: 10.3109/08977190903468185.
- 27. Dougherty EJ: An Evidence-Based Model Comparing the Cost-effectiveness of Platelet-Rich Plasma Gel to Alternative Therapies for Patients with Nonhealing Diabetic Foot Ulcers. Adv Skin Wound Care 2008; 21(12): 568‑75.
- 28. O’Connell SM, Impeduglia T, Hessler K et al.: Autologus platelet-rich fibrin matrix as cell therapy in the healing of chronic lower-extremity ulcers.Wound Rep Reg 2008; 16: 749‑56.
- 29. Crovetti G, Mrtinelli G, Issi M et al.: Platelet gel for healing cutaneus chronic wounds. Transfusion and Apheresis Science 2004; 30: 145‑51.
- 30. Cervelli V, Gentile P, Grimaldi M: Regenerative Surgery: use of fat grafting combined with platelet- rich plasma for chronic lower-extremity ulcers. Aesth Plast Surg 2009; 33: 340‑45.
Publication order reference