PRP application for the treatment of chronic wounds
Healing of wounds is a complex process influenced significantly by patient comorbidities, which in some cases lead to chronic non-healing wounds. Evidences presented in the medical literature supporting the clinical use of autologous Platelet-Rich Plasma (PRP) in treating such wounds are becoming increasingly compelling. Mechanisms involved include intricate interactions among the patient's own platelets, cytokines, and growth factors.
A chronic wound is defined as a defect in the skin barrier that persists beyond three months from injury, i.e., interruption of skin continuity. This represents a significant therapeutic challenge and is not uncommon among elderly patients, those with diabetes mellitus, and individuals with vascular disorders. Tissue repair is a universal phenomenon in all multicellular organisms, involving multiple specific mechanisms over various timeframes. Deviation from the normal physiological course of healing can result from various factors, such as poor blood supply, impaired immune function, or inadequate nutritional status of the patient. Chronic wounds can cause a significant reduction in the patient's quality of life and represent a substantial burden on the healthcare system.
Platelet-Rich Plasma (PRP) is a completely autologous product obtained from the patient's own blood, which contains high concentrations of platelets and various growth factors associated with successful tissue healing and regeneration. Using a special protocol, the patient's peripheral blood is centrifuged for 5-6 minutes to obtain platelet levels 2-5 times higher than in normal blood. The use of such plasma products was first described by hematologists in the 1960s and 1970s, and since then, it has been used in various surgical and non-surgical fields, such as dermatology, orthopedics and sports medicine. A recent systematic review and meta-analysis of randomized controlled trials have shown that Platelet-Rich Plasma therapy effectively enhances wound healing and is considered a sustainable option for biological adjuvant therapy in patients with non-healing diabetic foot ulcers.
Alpha granules found in platelets contain abundant growth factors, such as transforming growth factor beta 1 (TGF-B1), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin-like growth factor 1 (IGF-1), platelet-derived growth factor (PDGF), and fibroblast growth factor (FGF), believed to play a crucial role in the mechanisms of wound healing. Upon their release from alpha granules, numerous polypeptides and receptors are activated to enhance wound closure, achieved through well-known effects on cell differentiation and proliferation, chemotaxis, collagen synthesis, and angiogenesis. Due to the increased concentrations of all these factors, PRP accelerates wound healing. However, predicting and identifying prognostic factors for wound healing is challenging due to multifactorial pathogenesis and diverse etiology of the wound. Patients with diabetes have impaired healing capacity and are at risk of prolonged wound healing. One evaluation suggests that one in three to one in five patients with diabetes will develop a chronic non-healing wound during their lifetime. Patients without diabetes have better regulation of angiogenesis and local inflammatory response in wound healing, as well as a more effective immune response to colonizing bacteria, with lower levels of reactive oxygen species. Even when chronic wounds in diabetic patients heal, there is a risk of recurrence. The risk of recurrence within one year is approximately 40%, and within five years, it can be as high as 65%. Some risk factors for diabetic ulcer recurrence have also been identified, including the progression of neuropathy, wound infection, peripheral arterial disease, pre-ulcerative lesions, glycosylated hemoglobin greater than 7.5%, etc.
In summary, chronic wounds are a clinically exhausting issue, both for patients and physicians, and in advanced stages, they can even lead to amputation of the affected limb or other systemic septic conditions.
St. Catherine Specialty Hospital is proud of its well-established application of autologous plasma in orthopedic cases, and following a successful initial application for anal fissures, it is expanding its use of PRP therapy to the treatment of chronic wounds.
After specialist examination, if there is a valid indication for this type of therapy in an individual patient, it is applied in short notice as an outpatient, minimally invasive procedure. After drawing blood from a well-hydrated patient's vein, it is processed within a few minutes and then applied around the wound using a syringe and needle.
It is generally considered necessary to administer PRP for chronic wounds at least three times, with several weeks between applications. However, there are clinical situations where the number of required applications may be fewer or greater than average. The number of applications is decided on an individual basis during treatment, guided by an assessment of the adequacy of the clinical response, i.e., wound healing.
Chronic wounds inevitably severely diminish the quality of patients' daily lives. This is precisely why the application of regenerative medicine in the form of autologous patient plasma, without any risk of rejection or allergic reactions, through an outpatient procedure with minimal pain, is a highly promising approach. This procedure delivers "everything essential for wound healing" directly to these wounds, bypassing issues related to inadequate circulation and damage to peripheral blood vessels.
Suffering from chronic wounds and interested in finding out if you are a candidate for PRP therapy? Contact us with confidence and make an appointment using our contact form, calling at +385 1 2867 400 or via email at info@stcatherine.com
