INTRODUCTION: one session per week. Follow up of patients

INTRODUCTION:

Chronic wounds are a major cause of
disability and pain. These affect quality of life and are a source of financial
burden to patient and healthcare system. Chronic non healing ulcer may be venous, arterial, traumatic,
diabetic or postburn wounds. Their
pravelence in the world is from 1.9% to as high as 13%.  Greater than 85% of lower limb amputations
are preceded by foot or ankle ulcers. Healing is incomplete and slow process.
Conventional therapies such as dressing, surgical debridement, local
antiseptics, pressure dressing and skin grafting cant be much beneficial as
these don’t provide growth factors necessary for wound healing. This healing is
accelerated by providing higher than normal concentrations of growth factors
through administration of Platelet Rich Plasma.(1, 2)

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Platelet-rich plasma is a
biocompatible, inexpensive and simple method of obtaining above baseline
concentration of autologous platelets and growth factors. It contains multiple
growth factors like Vascular endothelial growth factor, Platelet derived growth
factor, Transforming growth factor, Interleukins, Epidermal Growth Factor and
fibronectin to promote all three phases of wound healing i.e inflammatory,
proliferative and remodeling phase. Moreover, PRP provides leukocytes to
inhibit infection. Autologous blood is centrifuged to get PRP. This study is
aimed to determine effectiveness of platelet rich plasma in non healing chronic
wounds.(3)

MATERIAL
AND METHODS:

After
clearance from ethical review committee (DEPARTMENT OF
MEDICAL EDUCATION, QMC, BAHAWALPUR), 12 patients with 15 ulcers were included
from August 2017 to November 2017 with following inclusion and exclusion
criteria.

INCLUSION
CRITERIA

 Patients previously treated conventionally for
ulcers for more than 12 weeks duration were included in the study. Ulcers were
having maximum diameter of 3cm.

EXCLUSION
CRITERIA

Patients with
drug abuse, steroid use, smoking, alcoholism, local necrotic tissue, foreign
body, bleeding disorder, uncontrolled sugar levels were excluded.

 

PRP was
given for a total duration of 8 weeks at the rate of one session per week.
Follow up of patients was done for 3 months. Response checked at the end of
third month. More than 80% reduction in diameter of ulcer was considered as
response to treatment in 3 months.

PRP is
plasma having platelet count two to eight folds more than normal plasma
platelet count. It was made by taking blood sample of patient. This blood was
centrifuged for 15 minutes at the rate of 5000 revolutions per minute with the
addition of sodium citrate. It separated RBCs from plasma and then it was
further centrifuged. We got supernatant plasma having low platelets and a thick
buffy coat having high amount of platelets. It was activated by addition of
calcium chloride. Thrombin can also be used in place of calcium. After the
activation of PRP gel, it was applied on wound that was properly debrided
having no necrotic tissue in it. Paraffin gauze was used for dressing.

RESULTS:

There were 8
patients having mean age of 43.88±10.16years. 5(62.5%) were males and
3(37.5%) were females. Duration of ulcers ranged from 3 months to 2 years with
mean of 9.87±6.26weeks. The mean duration of healing was ____weeks.
100% improvement in area of ulcer was seen in 2 patients(25%). The mean area of
ulcer before PRP was 2.31±0.45cm. The mean area of ulcer after 8
weeks PRP sessions was 0.36±0.24cm. The mean reduction in area was
1.97±0.55cm. The mean percentage reduction in area was 84.62±10.6%.

 

 

 

 

Figure 1Before PRP

Figure 2After PRP

 

 

 

 

 

On a scale
of 1-10 where 1 being the minimum and 10 being the maximum and 0 being no pain,
the mean pain before PRP was 6.12±0.83. The mean pain after PRP was 1.87±1.24. The mean decrease in pain was 4.50±1.60. The mean percentage decrease in pain was 71.75±20.03. No side effect noted.

 

 
Variables

Minimum

Maximum

Mean

Std.
Deviation

Patient Age(Years)

28

59

43.88

10.162

Duration of Ulcer(Weeks)

3.00

24.00

9.8750

6.26641

 Diameter of
Ulcer before PRP(cm)

1.70

3.00

2.3125

.45493

Diameter after PRP(cm)

.00

.70

.3625

.24458

Decrease in Diameter(cm)

1.30

3.00

1.9750

.54707

%age Decrease in Diameter

72

100

84.62

10.6

Duration of Healing(weeks

8.00

14.00

10.5000

2.07020

Pain before PRP

5.00

7.00

6.1250

.83452

Pain after PRP

.00

3.00

1.8750

1.24600

Decrease in Pain

2.00

7.00

4.5000

1.60357

%age Decrease in Pain

40

100

71.75

20.03

 

 

 

 

 

DISCUSSION:

                         The term PRP was created in the 1970s to describe the plasma with
a platelet counts more than that of blood. Initially PRP was used as a
transfusion product to treat patients having thrombocytopenia. Ten years later,
PRP started to be used in maxillofacial surgery. PRP is now used in the fields
of acute trauma, cosmetic surgery, dentistry, dermatology, plastic surgery and
maxillofacial surgery (4).

                            The findings from
our study suggest that platelet rich plasma promotes healing of chronic wounds.
Area of the wound dramatically decreased following platelet rich plasma
administration which was also associated with a significant reduction in pain.
A study conducted by Suthar and et al., on patients with non-healing ulcers
showed that all ulcers responded with a reduction in size in a mean duration of
8.2 weeks. In our study, mean duration for significant reduction in wound size
is 12 weeks (2).

                              Another study
conducted by Moneib and et al., showed that compared to conventional therapy, a
highly significant improvement in the ulcer size was seen post-PRP therapy. The
mean change in the area of the ulcer post-PRP and conventional therapy was 4.92
± 11.94 cm and 0.13 ± 0.27 cm, respectively. The mean percentage improvement in
the area of the ulcer post-PRP and conventional therapy was 67.6% ± 36.6% and
13.67% ± 28.06%, respectively. Subjective improvement in pain associated with
the ulcer was also noted by all the patients. 
In our study the reduction in diameter post PRP therapy was
1.97±0.55   cm and percentage improvement
in area was 84.62±10.60%. On a scale of 1-10 where 1 being the minimum and 10
the maximum pain, the mean reduction in pain after PRP was 4.50±1.60 (5).

                              In a study
conducted by Babaei and et al, significant wound
size reduction was detected in patients after four weeks of treatment.  Out of total 150 wounds in 150 patients, no wound was reopened after eight months of monitoring (6)

 

 

CONCLUSION:

Chronic
wound management is always difficult. PRP is a regenerative medicine approach
which provides effective wound healing of the chronic wounds which otherwise
fail to heal. More randomized controlled trial should be done to compare the
efficacy of PRP with conventional treatments for healing of chronic ulcers.

 

REFERENCES:

1.         Alves
R, Grimalt R. A Review of Platelet-Rich Plasma: History, Biology, Mechanism of
Action, and Classification. Skin Appendage Disorders. 2018;4(1):18-24.

2.         Suthar
M, Gupta S, Bukhari S, Ponemone V. Treatment of chronic non-healing ulcers
using autologous platelet rich plasma: a case series. Journal of biomedical
science. 2017;24(1):16.

3.         Moneib
HA, Youssef SS, Aly DG, Rizk MA, Abdelhakeem YI. Autologous platelet?rich
plasma versus conventional therapy for the treatment of chronic venous leg
ulcers: A comparative study. Journal of cosmetic dermatology. 2017.

4.         Babaei V, Afradi H, Gohardani H,
Nasseri F, Azarafza M, Teimourian S. Management of chronic diabetic foot ulcers
using platelet-rich plasma. Journal of wound care.   2017;26(12):784-7.