Platelet-Rich Fibrin, Preparation and Use in Dermatology

Shuken Dashore, Kavish Chouhan, Soni Nanda, Aseem Sharma, Shuken Dashore, Kavish Chouhan, Soni Nanda, Aseem Sharma

Abstract

The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich fibrin (PRF) and its use in various dermatological indications. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its taskforce on platelet-rich plasma. A comprehensive literature search was done in the English language on the PRF across multiple databases. The grade of evidence and strength of recommendation was evaluated on the GRADE framework (Grading of Recommendation, Assessment, Development and Evaluation). A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. A total of 40 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books] and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends use of A-PRF+ protocol, that is (200 g for 8 min) for preparation of solid PRF and C-PRF protocol (700 g for 8 min) for liquid PRF. Swing out bucket model of centrifuge or the horizontal centrifuge is recommended for preparation of both PRF, and liquid PRF. Centrifugation must begin within 90-120 s of drawing of blood. PRF can be used in various indications for skin rejuvenation and nonhealing ulcers as either monotherapy or in combination with other therapies.

Keywords: A-PRF; C-PRF; I-PRF; RCF; RPM; centrifuge; platelet-rich fibrin guidelines; platelet-rich plasma; preparation; recommendations; regenerative medicine; standardization.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2021 Indian Dermatology Online Journal.

Figures

Figure 1
Figure 1
Shows schematic representation of different types of second generation platelet concentrates that can be prepared using different centrifugation protocols and tubes. Light yellow colour represents cell free plasma, orange colour represents plasma containing cells predominantly platelets and red colour represents RBC layer
Figure 2
Figure 2
Black arrows show paths that cells take when tubes containing blood are centrifuged. (a) In a fixed angle centrifuge, the cells first hit the distal part of the tube and then start to creep up or down along the back wall of the tube. (b) In swinging bucket model or horizontal centrifuge, there is unhindered movement of platelets and RBC
Figure 3
Figure 3
Shows the smearing of cells on the back wall of the tube in a fixed angle centrifuge indicating risk of cell damage
Figure 4
Figure 4
Schematic representation of fixed angle centrifuge with different angles. With the same Rmax (Maximum radius) these two centrifuges deliver different forces
Figure 5
Figure 5
Schematic representation of the position of platelets in a PRF clot produced using a fixed angle centrifuge
Figure 6
Figure 6
Shake test to test for the presence of additives in tubes. (a) Turbidity in the tube suggests presence of additives in the tubes. (b) Clear water in the tube suggests that there is no additive in the tube
Figure 7
Figure 7
18 G 1.5 inch needle is used to pick up I-PRF by passing it through the rubber stopper. This allows I-PRF to stay in closed containers during the whole preparation process
Figure 8
Figure 8
Step by step process for making Platelet Rich Fibrin using A-PRF + protocol
Figure 9
Figure 9
Step by step process for making liquid Platelet Rich Fibrin using I-PRF protocol
Figure 10
Figure 10
Step by step process for making liquid Platelet Rich Fibrin using C-PRF protocol
Figure 11
Figure 11
I-PRF prepared in white top additive free PET plastic vacutainer. 1-1.5 mL is produced in each tube
Figure 12
Figure 12
C-PRF prepared in white top additive free PET plastic vacutainer. 0.3-0.5 mL taken from the buffy coat region. The position of buffy coat is much lower in case of C-PRF as compared to I-PRF due to higher centrifugation speeds
Figure 13
Figure 13
Intradermal injection of nasolabial fold with I-PRF. (a) Before treatment. (b) Immediately after treatment

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