Proficiency of topical platelet-rich plasma with vacuum-assisted closure over platelet-rich plasma alone in diabetic foot ulcers – A clinical, prospective, comparative study

Document Type : Original Article

Authors

1 Department of Orthopedics, Government Medical College, Amritsar, Punjab, India

2 Department of Anatomy, AIIMS, Bathinda, Punjab, India

3 Department of Orthodontics, SGRD Institute of Dental Sciences, Amritsar, Punjab, India

10.4103/atr.atr_43_21

Abstract

Background and Objectives: Type 2 diabetes mellitus is usually associated with peripheral neuropathy, peripheral vascular disease with consequential limb ischemia, and eventually diabetic foot ulcers (DFUs). The healing process is slow due to microangiopathy and wound is easily infected with microbials leading to superficial infection, progressing to deep infection, and eventually landing in amputation most of the times. Platelet-rich plasma (PRP) is very cost effective, readily available blood derivative and has the capability to stimulate cell proliferation and differentiation. It improves tissue healing and regeneration and exhibit potent activities against a number of pathogens. Vacuum-assisted closure (VAC), on the other hand, is a new novel way to treat DFUs by having negative pressure wound healing. The present study focused on the advantage of (PRP + VAC) dressing over (topical PRP application with its peripheral injection) alone for aiding and enhancing the process of wound healing in DFU. Materials and Methods: This was a prospective comparative study of 100 cases to compare the outcomes of wound healing by topical PRP application with its peripheral injection. Results: Mean time taken for the appearance of granulation tissue, 100% granulation tissue, average reduction in wound surface area, showed significant (P ≥ 0.005) differences between the (PRP + VAC) and the (topical PRP application with its peripheral injection) dressing groups. Conclusions: (PRP + VAC) dressings are more effective than conventional (topical PRP application with its peripheral injection) dressings in wound healing of DFUs.

Keywords

References

1.
Eppley BL, Pietrzak WS, Blanton M. Platelet-rich plasma: A review of biology and applications in plastic surgery. Plast Reconstr Surg 2006;118:147e-59e.  Back to cited text no. 1
    
2.
Sclafani AP, Azzi J. Platelet preparations for use in facial rejuvenation and wound healing: A critical review of current literature. Aesthetic Plast Surg 2015;39:495-505.  Back to cited text no. 2
    
3.
Kim DH, Je YJ, Kim CD, Lee YH, Seo YJ, Lee JH, et al. Can platelet-rich plasma be used for skin rejuvenation? Evaluation of effects of platelet-rich plasma on human dermal fibroblast. Ann Dermatol 2011;23:424-31.  Back to cited text no. 3
    
4.
Carter CA, Jolly DG, Worden CE Sr., Hendren DG, Kane CJ. Platelet-rich plasma gel promotes differentiation and regeneration during equine wound healing. Exp Mol Pathol 2003;74:244-55.  Back to cited text no. 4
    
5.
Lindeboom JA, Mathura KR, Aartman IH, Kroon FH, Milstein DM, Ince C. Influence of the application of platelet-enriched plasma in oral mucosal wound healing. Clin Oral Implants Res 2007;18:133-9.  Back to cited text no. 5
    
6.
Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004;91:4-15.  Back to cited text no. 6
    
7.
Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: A review and author's perspective. J Cutan Aesthet Surg 2014;7:189-97.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: A milieu of bioactive factors. Arthroscopy 2012;28:429-39.  Back to cited text no. 8
    
9.
Everts PA, Knape JT, Weibrich G, Schönberger JP, Hoffmann J, Overdevest EP, et al. Platelet-rich plasma and platelet gel: A review. J Extra Corpor Technol 2006;38:174-87.  Back to cited text no. 9
    
10.
Marx RE. Platelet-rich plasma: Evidence to support its use. J Oral Maxillofac Surg 2004;62:489-96.  Back to cited text no. 10
    
11.
Alves R, Grimalt R. A review of platelet-rich plasma: History, biology, mechanism of action, and classification. Skin Appendage Disord 2018;4:18-24.  Back to cited text no. 11
    
12.
Chan RK, Liu P, Lew DH, Ibrahim SI, Srey R, Valeri CR, et al. Expired liquid preserved platelet releasates retain proliferative activity. J Surg Res 2005;126:55-8.  Back to cited text no. 12
    
13.
Sclafani AP, McCormick SA. Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix. Arch Facial Plast Surg 2012;14:132-6.  Back to cited text no. 13
    
14.
Eppley BL, Pietrzak WS, Blanton M. Platelet-rich plasma: A review of biology and applications in plastic surgery. Plast Reconstr Surg 2006;118:147e-159e.  Back to cited text no. 14
    
15.
Andia I, Abate M. Platelet-rich plasma: Underlying biology and clinical correlates. Regen Med 2013;8:645-58.  Back to cited text no. 15
    
16.
Venturi ML, Attinger CE, Mesbahi AN, Hess CL, Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: A review. Am J Clin Dermatol 2005;6:185-94.  Back to cited text no. 16
    
17.
Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg 1997;38:553-62.  Back to cited text no. 17
    
18.
Horch RE. Basics foundation and results of the vacuum therapy in the reconstructive surgery. Zentralbl Chir 2004;129 Suppl 1:S2-5.  Back to cited text no. 18
    
19.
Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: Microdeformations of wounds and cell proliferation. Plast Reconstr Surg 2004;114:1086-96.  Back to cited text no. 19
    
20.
Renner R, Rogalski C, Friedlein H, Simon JC. Vacuum therapy in dermatology: A review J Dtsch Dermatol Ges 2006;4:468-76.  Back to cited text no. 20
    
21.
Driver VR, Hanft J, Fylling CP, Beriou JM; Autologel Diabetic Foot Ulcer Study Group. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage 2006;52:68-70, 72, 74.  Back to cited text no. 21
    
22.
Lee HJ, Kim JW, Oh CW, Min WK, Shon OJ, Oh JK, et al. Negative pressure wound therapy for soft tissue injuries around the foot and ankle. J Orthop Surg Res 2009;4:14.  Back to cited text no. 22
    
23.
Arcand V, Born C, Bliss J, Ray J, Patel A. Negative pressure wound therapy and its application in orthopaedics Part II: Clinical application. Osteosynth Trauma Care 2006;14:254-8.  Back to cited text no. 23
    
24.
Moura LI, Dias AM, Carvalho E, de Sousa HC. Recent advances on the development of wound dressings for diabetic foot ulcer treatment – A review. Acta Biomater 2013;9:7093-114.  Back to cited text no. 24
    
25.
Kargar S, Javadzadeh Shahshahani H, Tabkhi N. The effect of platelet gel on the treatment of diabetic foot ulcer. Sci J Iran Blood Transfus Org 2010;6:283-91.  Back to cited text no. 25
    
26.
Lacci KM, Dardik A. Platelet-rich plasma: Support for its use in wound healing. Yale J Biol Med 2010;83:1-9.  Back to cited text no. 26
    
27.
Mehrannia M, Vaezi M, Yousefshahi F, Rouhipour N. Platelet rich plasma for treatment of nonhealing diabetic foot ulcers: A case report. Can J Diabetes 2014;38:5-8.  Back to cited text no. 27
    
28.
Tran TD, Le PT, Van Pham P. Diabetic foot ulcer treatment by activated platelet rich plasma: A clinical study. Biomed Res Ther 2014;1:1-6.  Back to cited text no. 28
    
29.
Suthar M, Gupta S, Bukhari S, Ponemone V. Treatment of chronic non-healing ulcers using autologous platelet rich plasma: A case series. J Biomed Sci 2017;24:16.  Back to cited text no. 29
    
30.
Horn SD, Fife CE, Smout RJ, Barrett RS, Thomson B. Development of a wound healing index for patients with chronic wounds. Wound Repair Regen 2013;21:823-32.  Back to cited text no. 30
    
31.
Albanese A, Licata ME, Polizzi B, Campisi G. Platelet-rich plasma (PRP) in dental and oral surgery: From the wound healing to bone regeneration. Immun Ageing 2013;10:23.  Back to cited text no. 31
    
32.
Lone AM, Zaroo MI, Laway BA, Pala NA, Bashir SA, Rasool A. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: A prospective case-control study. Diabet Foot Ankle 2014;5:1-5. [doi: 10.3402/dfa.v5.23345].  Back to cited text no. 32
    
33.
Lehrman JD. Combining the benefits of collagen and negative pressure wound therapy to heal a chronic diabetic foot ulcer: A case report. Wounds 2020;32:E11-3.  Back to cited text no. 33
    
34.
Cervelli V, Gentile P, Scioli MG, Grimaldi M, Casciani CU, Spagnoli LG, et al. Application of platelet-rich plasma in plastic surgery: Clinical and in vitro evaluation. Tissue Eng Part C Methods 2009;15:625-34.  Back to cited text no. 34
    
35.
Swaminathan AG, Subramanian CS, Sundaram S. Novel effective treatment for diabetic foot ulcers [DFU] by vacuum assisted wound closure therapy. Int J Surg Sci 2020;4:458-61.  Back to cited text no. 35
    
36.
Ahmed G, Khalil AA, Hawary AK, Samy A, Eldin SS, Ahmed MB. Comparative study between negative pressure wound therapy and platelet rich plasma in neovascularization of chronic wound healing. Egypt J Plast Reconstr Surg 2018;42:35-43.  Back to cited text no. 36
    
37.
Gurvich L. Synergism in using negative pressure wound therapy with alternated applications of autologous platelet-derived growth factors in treating post-acute surgical wounds. Wounds 2009;21:134-40.  Back to cited text no. 37
    
Archives of Trauma Research
Volume 11, Issue 1
March 2022
Pages 37-43

Files

History

  • Receive Date: 18 June 2023
  • Accept Date: 18 June 2023

Share

How to cite

Statistics