Leucocyte- and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities
Kadri Ozer, Ozlem Colak, Kadri Ozer, Ozlem Colak
Abstract
Background: Generally, advanced wound care resources are applied for complex wounds that pose a challenge to the medical and nursing teams. In this report, the use of leukocyte- and platelet-rich fibrin (L-PRF) is emphasized for complex wounds as an alternative, simple, inexpensive, time-saving process that does not require hospitalization and has a healing potential over that of bare soft tissue, including bone, tendon, and ligaments. The aim of this study is to extend the use of L-PRF in small-to-moderate-sized complex wounds of lower extremities in which L-PRF maintains the sensitive structures viable.
Methods: Between January 2016 and December 2017, 17 small-to-moderate-sized complex wounds of lower extremities treated with L-PRF were recruited from the plastic and reconstructive surgery clinic in Aydin State Hospital, Turkey. The treatment was administered twice per week in the outpatient clinic. Depending on the size and extension of the complex wound, two to five blood samples were collected into 8.5 ml dry, glass vacuum tubes with no anticoagulant, and samples were immediately centrifuged at 1630×g for 5 min to obtain L-PRF. Complete healing was defined as the day of complete wound epithelialization.
Results: The median values of the initial wound size and wound duration were 12 cm2 (interquartile range, 6 to 23 cm2) and 8 months before first admission (interquartile range, 4 to 18 months), respectively. All wounds showed significant improvements after L-PRF therapy and full closure after a median of 18 months, with an interquartile range of 11 to 34 months of L-PRF applications. There were recurrences of wounds during the first 6 months after therapy. No adverse events were observed.
Conclusions: Our results add to the growing evidence that L-PRF treatments protect and maintain bare soft tissue structures viable, facilitate the formation of granulation tissue and epithelization, and remarkably reduce the need for additional soft tissue surgeries in small-to-medium-sized complex wounds.
Keywords: Bare bone; Bare tendon; Complex wound; Leukocyte- and platelet-rich fibrin.
Conflict of interest statement
Ethical approval was obtained before the study by the ethics committee of Ankara Training and Research Hospital.Written informed consent was obtained from the patients for the publication of this article and any accompanying images.The authors declare that they have no competing interests.
Figures
References
- Greer N, Foman NA, MacDonald R, Dorrian J, Fitzgerald P, Rutks I, et al. Advanced wound care therapies for nonhealing diabetic, venous, and arterial ulcers: a systematic review. Ann Intern Med. 2013;159:532–542. doi: 10.7326/0003-4819-159-8-201310150-00006.
- Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17:763–771. doi: 10.1111/j.1524-475X.2009.00543.x.
- The global advanced wound care market (MCP-6191). 2016. Available from: .
- Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care. 2015;4:560–582. doi: 10.1089/wound.2015.0635.
- Werdin F, Tennenhaus M, Schaller H-E, Rennekampff H-O. Evidence-based management strategies for treatment of chronic wounds. Eplasty. 2009;9:e19.
- Ferreira MC, Tuma P, Carvalho VF, Kamamoto F. Complex wounds. Clinics (Sao Paulo) 2006;61:571–578. doi: 10.1590/S1807-59322006000600014.
- Pinto NR, Ubilla M, Zamora Y, Del Rio V, Dohan Ehrenfest DM, Quirynen M. Leucocyte- and platelet-rich fibrin (L-PRF) as a regenerative medicine strategy for the treatment of refractory leg ulcers: a prospective cohort study. Platelets Taylor & Francis. 2017;00:1–8.
- Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:638–646. doi: 10.1016/S1079-2104(98)90029-4.
- Magalon J, Bausset O, Serratrice N, Giraudo L, Aboudou H, Veran J, et al. Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model. Arthroscopy. 2014;30:629–638. doi: 10.1016/j.arthro.2014.02.020.
- Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Fibrin CJP-R, Healing STW. A systematic review. Tissue Eng Part B Rev. 2016;23:0233.
- Akhundov K, Pietramaggiori G, Waselle L, Darwiche S, Guerid S, Scaletta C, et al. Development of a cost-effective method for platelet-rich plasma (PRP) preparation for topical wound healing. Ann Burns Fire Disasters. 2012;25:207–213.
- Dohan Ehrenfest DM, Del Corso M, Diss A, Mouhyi J, Charrier J-B. Three-dimensional architecture and cell composition of a Choukroun’s platelet-rich fibrin clot and membrane. J Periodontol. 2010;81:546–555. doi: 10.1902/jop.2009.090531.
- Dohan Ehrenfest DM, Del Corso M, Inchingolo F, Sammartino G, Charrier JB. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in human cell cultures: growth factor release and contradictory results. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2010;110:418–421. doi: 10.1016/j.tripleo.2010.05.059.
- Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun’s platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009;27:63–69. doi: 10.1080/08977190802636713.
- Chignon-Sicard B, Georgiou CA, Fontas E, David S, Dumas P, Ihrai T, et al. Efficacy of leukocyte- and platelet-rich fibrin in wound healing: a randomized controlled clinical trial. Plast Reconstr Surg. 2012;130:819e–829e. doi: 10.1097/PRS.0b013e31826d1711.
- Steenvoorde P, van Doorn LP, Naves C, Oskam J. Use of autologous platelet-rich fibrin on hard-to-heal wounds. J Wound Care. 2008;17:60–63. doi: 10.12968/jowc.2008.17.2.28179.
- Bielecki T, Dohan Ehrenfest DM, Everts PA, Wiczkowski A. The role of leukocytes from L-PRP/L-PRF in wound healing and immune defense: new perspectives. Curr Pharm Biotechnol. 2012;13:1153–1162. doi: 10.2174/138920112800624373.
- Kobayashi M, Kawase T, Okuda K, Wolff LF, Yoshie H. In vitro immunological and biological evaluations of the angiogenic potential of platelet-rich fibrin preparations: a standardized comparison with PRP preparations. Int J Implant Dent. 2015;1:31. doi: 10.1186/s40729-015-0032-0.
- Choukroun J., Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. European Journal of Trauma and Emergency Surgery. 2017;44(1):87–95. doi: 10.1007/s00068-017-0767-9.
- Ghanaati S, Booms P, Orlowska A, Kubesch A, Lorenz J, Rutkowski J, et al. Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol. 2014;40:679–689. doi: 10.1563/aaid-joi-D-14-00138.
- Fujioka-Kobayashi Masako, Miron Richard J., Hernandez Maria, Kandalam Umadevi, Zhang Yufeng, Choukroun Joseph. Optimized Platelet-Rich Fibrin With the Low-Speed Concept: Growth Factor Release, Biocompatibility, and Cellular Response. Journal of Periodontology. 2017;88(1):112–121. doi: 10.1902/jop.2016.160443.
- Cho J-W, Kim S-A, Lee K-S. Platelet-rich plasma induces increased expression of G1 cell cycle regulators, type I collagen, and matrix metalloproteinase-1 in human skin fibroblasts. Int J Mol Med. 2012;29:32–36. doi: 10.3892/ijmm.2012.879.
- Perez AGM, Lana JFSD, Rodrigues AA, Luzo ACM, Belangero WD, Santana MHA. Relevant aspects of centrifugation step in the preparation of platelet-rich plasma. ISRN Hematol. 2014;2014:176060. doi: 10.1155/2014/176060.
- Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Król W, Wielkoszynski T. Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: an in vitro study. J Bone Joint Surg Br. 2007;89:417–420. doi: 10.1302/0301-620X.89B3.18491.
- Schär MO, Diaz-Romero J, Kohl S, Zumstein MA, Nesic D. Platelet-rich concentrates differentially release growth factors and induce cell migration in vitro. Clin Orthop Relat Res. 2015;473:1635–1643. doi: 10.1007/s11999-015-4192-2.
- Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med. 2011;39:2135–2140. doi: 10.1177/0363546511417792.
Source: PubMed