Abstract and Introduction
Introduction: Diabetic foot ulcers (DFUs) are a major complication of diabetes. Recently, considerable progress has been achieved in techniques that promote wound healing. Autologous platelet-rich plasma (PRP) is one such technique that is gaining popularity. Platelet-rich plasma is thought to stimulate wound healing by releasing growth factors essential for healing.
Objective: This research aimed to study the efficacy of PRP in managing chronic DFUs.
Materials and Methods: Seventy-two patients with chronic DFUs were equally divided into 2 groups. The first group was treated with activated PRP injection and gel on the surface of the ulcer, and the second group was treated with conventional dressing using normal saline to irrigate the wound, followed by coverage with petrolatum gauze and sterile dressing.
Results: Both methods of treatment improved healing, but there was a significant increase in healing rate among the PRP group compared with the conventional dressing group (31/36 patients [86.11%] vs 23/36 patients [63.89%]; P =.029). Additionally, the healing duration was shorter in the PRP group than in the conventional dressing group (10.90 weeks ± 3.40 standard deviation vs 13.48 weeks ± 3.37, respectively; P =.01).
Conclusions: The use of autologous PRP results in a higher rate of wound healing in less time compared with conventional wound care in managing DFUs. Platelet-rich plasma is an effective and promising treatment for chronic DFUs; PRP enables healing in less time. This is expected to positively affect the individual's performance and minimize long-term health care expenditure on foot ulcers.
The term chronic wound was first used in the literature in the 1950s to refer to wounds that were difficult to heal or did not follow a normal healing process. However, the term has been met with criticism for its uncertainty regarding the duration of chronicity. Martin and Nunan define a chronic wound as a barrier defect that has not healed in 3 months, and Leaper and Durani define it as a wound that does not reduce 20% to 40% in size after 2 to 4 weeks of optimal treatment or when healing is incomplete after 6 weeks. Sheehan et al considered patients eligible for enrollment in their study if they had a diabetic foot ulcer (DFU) of more than 30 days' duration.
Diabetic foot ulcers are a major complication of diabetes mellitus and the major component of diabetic foot syndrome. This medical condition affects 15% of all patients with diabetes mellitus. In 2012, Alvarsson et al reported that up to 88% of all lower leg amputations were related to DFUs.
The effect of chronic wounds on the health and quality of life for patients and their caregivers should not be underestimated. Patients with chronic wounds may experience chronic pain, loss of function and mobility, depression and anxiety, increased social stress and isolation, prolonged hospitalization, increased financial burden, and increased morbidity and mortality.
Growth factors play an essential role in wound healing and tissue regeneration. Each growth factor has more than 1 effect on the healing process and acts by binding to specific cell membrane receptors on the target cells. The effects of growth factors include promoting chemotaxis, inducing cell migration and proliferation, and stimulating upregulating protein production. Growth factors not only regulate cell migration and proliferation but also promote angiogenesis and remodel the extracellular matrix, creating an ideal environment that favors the cutaneous wound healing process.
Since the 1990s, the use of emerging cellular therapies, particularly platelet-rich plasma (PRP), has gained more attention for a variety of diseases and in a variety of settings for its potential use in regenerative medicine as a therapeutic agent; additionally, it can have an adjunctive role in a standardized, quality treatment plan. The use of PRP, which is rich in growth factors and cytokines that may enhance the natural wound healing process, is gaining popularity.
Platelet-rich plasma is defined as plasma containing concentrations of platelets above baseline, from 150 × 103/dL to 400 × 103/dL. Platelet-rich plasma is isolated through the centrifugation of whole blood. Its actions are based on the infusion of an increased number of platelets, thereby theoretically enhancing the biologic healing capacity as well as tissue generation in the wound bed. Enzyme-linked immunosorbent assay studies of PRP have quantified the presence of increases in growth factors such as transforming growth factor β, epidermal growth factor, and platelet-derived growth factor. Through degranulation of the alpha granules in platelets, PRP can release various growth factors that have been documented to initiate the wound healing process. The goal of this study was to evaluate the efficacy of autologous PRP in managing chronic DFUs.
Wounds. 2022;34(2):36-42. © 2022 HMP Communications, LLC