A clinical study of platelet rich plasma versus conventional dressing in management of diabetic foot ulcers
Keywords:Conventional ordinary dressing, Diabetic foot ulcer, Healing outcomes, Platelet-rich plasma
Background: Diabetic foot ulcers continue to pose significant global issue despite the advances made in the management of diabetes. It causes major foot complications if they are not addressed properly. It needs multidisciplinary approach for its care. While several advancements has taken place in wound care management, platelet rich plasma and stem cell therapy promises to offer a new hope in its management, aiding in cellular and tissue regeneration. The purpose of the present study was to compare Platelet-Rich Plasma versus conventional dressing in the management of diabetic foot ulcers.
Methods: This prospective study was focused on 20 diabetic foot ulcers, carried out in a surgical unit of ACS Medical College and Hospital, Chennai, Tamil Nadu, from January 2018 to June 2018. Patients were divided into two groups; Group A received conventional ordinary dressing (N=10, 50%) and Group B received PRP dressing (N = 10, 50%). The mean follow-up period was 8 weeks.
Results: The estimated time of wound healing was 8 weeks and healing was found to be more effective for patients in group B compared to patients in group A; the PRP group was found to be more effective in wound healing with fewer complications, less infection, exudates and pain.
Conclusions: There have been considerable advances in the use of PRP in therapeutic processes in recent years in tissue regeneration therapy. PRP is a powerful tool for the treatment of chronic wounds and very promising for diabetic foot wounds; PRP enables healing, and reduces amputation rates, infection and exudates.
Willrich M, Pinzur M, McNeil D, Juknelis A, Lavery L. Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study. Foot Ankle Int. 2005;26:128-34.
Apelqvist G, Ragnarson U, Persson J, Larsson J. Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation. J Int Med. 1994;235:463-71.
Loot MA, Kenter SB, Au FL. Fibroblasts derived from chronic diabetic ulcers differ in their response to stimulation with EGF, IGF-I, bFGF and PDGF-AB compared to controls. Eur J Cell Biol. 2002;81:1530-60
Steed DL. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity ulcers. Plast Reconstr Surg. 2006;117:143s-9s.
Ronfard V, Williams T. Developments in cell-based therapy for wounds. In: Ronfard V, Williams T, editors. Advances in wound care. Volume. New Rochelle, NY: Mary Ann Liebert Inc. Publications; 2012;1:412-8.
Gentzkow GD, Iwasaki SD, Hershon KS. Use of dermagraft, a cultured human dermis, to treat diabetic foot ulcers. Diabetes Care. 2003;19:350-4.
Mulder G, Tallis A, Marshall V. Treatment of non-healing diabetic foot ulcers with a platelet-derived growth factor gene-activated matrix (GAM501): results of a phase 1/2 trial. Wound Repair Regen. 2009;17:772-9.
Blume P, Driver V, Tallis A. Formulated collagen gel accelerates healing rate immediately after application in patients with diabetic foot ulcers. Wound Repair Regen. 2011;19:302-8.
Russell R, Apostolakos J, Hirose T, Cote M, Mazzocca A. Variability of platelet-rich plasma preparations. Sports Med Arthrosc. 2013;21:186-90.
Marques L, Stessuk T, Camargo I, Junior SN, Santos L, Ribeiro-Paes J. Platelet-rich plasma (PRP): methodological aspects and clinical applications. Platelets. 2015;26:101-13.
Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008;1:165-74.
Giacco F, Perruolo G, D’Agostino E, Fratellanza G, Perna E, Misso S, et al. Thrombin-activated platelets induce proliferation of human skin fibroblasts by stimulating autocrine production of insulin-like growth factor-1. FASEB J. 2006;20:2402-4.
Moshiri A, Oryan A. Role of platelet rich plasma in soft and hard connective tissue healing: an evidence based review from basic to clinical application. Hard Tissue. 2013;2:6.
Kathleen M, Lacci B, Dardik A. Platelet-rich plasma: support for its use in wound healing. Yale J Biol Med. 2010;83:1-9.
De Pascale M, Sommese L, Casamassimi A, Napoli C. Platelet derivatives in regenerative medicine: an update. Transfus Med Rev. 2015;29:52-61.
Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev. 2012;10:89-92.
Moraes V, Lenza M, Tamaoki M, Faloppa F, Belloti J. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2013;12:42-9.
Anitua E, Aguirre J, Algorta J, Ayerdi E, Cabezas A, Orive G, Andia I. Effectiveness of autologous preparation rich in growth factors for the treatment of cutaneous ulcers. J Biomed Mater Res Part B Appl Biomater. 2008;84:415-21.
Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10:225-8.
De Leon MJ, Driver VR, Fylling CP, Carter MJ, Anderson C, Wilson J, et al. The clinical relevance of treating chronic wounds with an enhanced nearphysiological concentration of PRP gel. Adv Skin Wound Care. 2011;24:357-68.
Saad H, Elshahat A, Elsherbiny K, Massoud K, Safe I. Platelet-rich plasma versus platelet-poor plasma in the management of chronic diabetic foot ulcers: a comparative study. Int Wound J. 2011;8:307-12.
Gui-Qiu S, Ya-Ni Zhang B, Jing M, Yan-Hui L, Da-Ming Z, Jin-Lang Q, et al. Evaluation of the effects of homologous platelet gel on healing lower extremity wounds in patients with diabetes. Int J Low Extrem Wounds. 2013;12:22-9.
Amable PR, Carias RB, Teixeira MV, da Cruz Pacheco I, Correa do Amaral RJ, Granjeiro JM, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther. 2013;4:67.
Delbridge L, Ctercteko G, Fowler C, Reeve T, Le Quesne L. The etiology of diabetic neuropathic ulceration of the foot. Br J Surg. 2006;72:1-6.
Van Buul G, Koevoet W, Kops N, Bos P, Verhaar J, Weinans H, et al. Platelet-rich plasma release inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med. 2011;39:2362-70.
Crovetti G, Martinelli G, Issi M. Platelet gel for healing cutaneous chronic wounds. Transfus Apher Sci. 2009;30:145-51.
Villela V, Falanga A, Brem H, Ennis W, Wolcott R, Gould L, et al. Role of PRP and maintenance debridement in treatment of difficult-to-heal Chronic wounds. Ostomy Wound Manage. 2010:2-13.
Huang S, Wang Z. Influence of PRP on proliferation and osteogenic differentiation of skeletal muscle satellite cells: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110:453-62.
McAleer JP, Sharma SG, Kaplan EM, Persich GZ. Use of autologous platelet concentrate in a non-healing lower extremity wound. Adv Skin Wound Care. 2007;19:354-63.
Gelf JM, Hoffstad OZ, Margolis DJ. Surrogate endpoints for the treatment of diabetic leg ulcers. J Invest Dermatol. 2012;119:1420-5.
Gandhi A, Bibbo C, Pinzur M, Lin S. Role of platelet-rich plasma in foot and ankle surgery. Foot Ankle Clin. 2009;10:621-37.