The effectiveness of intralesional injection of platelet-rich plasma in accelerating the healing of chronic ulcers: an experimental and clinical study

Dimitrios Dionyssiou, Efterpi Demiri, Pericles Foroglou, Aggeliki Cheva, Nikolaos Saratzis, Constantine Aivazidis, George Karkavelas, Dimitrios Dionyssiou, Efterpi Demiri, Pericles Foroglou, Aggeliki Cheva, Nikolaos Saratzis, Constantine Aivazidis, George Karkavelas

Abstract

The purpose of this prospective experimental and clinical study is to evaluate the effectiveness of the intralesional injection of platelet-rich plasma (PRP), in the management of non-healing chronic wounds. Skin defects were created in the ears of 20 white New Zealand rabbits. In the study group, autologous PRP was injected intralesionally. The control group was treated conservatively. Nineteen out of 20 cases of the study group healed within a mean time of 24·9 days. In the control group, seven defects healed within a mean period of 26·7 days, seven ulcers did not heal at day 28 and in six cases a full thickness ear defect was recorded. For a 3-year period, 26 patients with chronic ulcers underwent surgical debridement and intralesional injection of PRP. A histological study was performed before and 7 days after PRP injection. Ten patients healed within a mean period of 7 weeks. In 16 cases, PRP prepared the wound bed for the final and simpler reconstructive procedure. Intralesional injection is a newly described method for application of PRP and represents an effective therapeutic option when dealing with non-healing wounds.

Keywords: Chronic ulcer; Intralesional injection; Platelet-rich plasma.

© 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

Figures

Figure 1
Figure 1
Skin defects up to the level of the perichondrium, measuring 2 × 2 cm at the external surface of the rabbits' pinna.
Figure 2
Figure 2
Injection of autologous platelet‐rich plasma at the margins of the ulcer.
Figure 3
Figure 3
The ulcer at the right (study) ear of the rabbit is completely healed, while the ulcer at the left (control) ear led to a full thickness defect.
Figure 4
Figure 4
(A) Histological result of a ‘study’ specimen suggested organised interconnecting collagen fibres running parallel to each other. (B) Specimen of the ‘control’ group showed absence of cartilage.
Figure 5
Figure 5
Intralesional injection of platelet‐rich plasma in an equal distribution at the wound edges and bed of the ulcer.
Figure 6
Figure 6
Chronic ulcer of the lower limb before (A) and 7 days after the platelet‐rich plasma injection (B) with a macroscopic improved lesion; intense presence of granulation tissue, reduction of the depth of the wound and epithelial deposition at the edges of the wounds.
Figure 7
Figure 7
Ulcer of the epidermis before platelet‐rich plasma (PRP) treatment with a severe collagen orientation (A) [×40 haematoxylin and eosin (H & E)] and 7 days after PRP intralesional injection (B) (×20 H& E). A better orientation of collagen at the deep area is documented.
Figure 8
Figure 8
Tissue of the ulcer before platelet‐rich plasma (PRP) treatment with a severe collagen orientation (A) (×100 mason) and 7 days after PRP intralesional injection (B) (×100 mason). A better orientation of collagen is documented.
Figure 9
Figure 9
(A) An unhealed 9 months' ulcer of the lower limb of a 62 year old female patient. (B) Successful conservative treatment with intralesional platelet‐rich plasma injection. The wound remained intact 18 months after treatment.
Figure 10
Figure 10
(A) Chronic ulcer of an amputated lower limb. (B) A complete take of the skin graft 3 months after surgery.

Source: PubMed

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