Recovery from deep-plane rhytidectomy following unilateral wound treatment with autologous platelet gel: a pilot study

Evidence of Hematoma Prevention After Facelift

Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation, such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed that identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size of fewer than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text, with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia rather than general anesthesia, and strict blood pressure control of at least <140 mmHg were found to significantly reduce hematoma formation. Quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors, and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunct measures have been shown to reduce postoperative hematoma formation in facelift procedures.

LEVEL OF EVIDENCE: 3

Tissue Sealants for Facial Rhytidectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: The aging face can be surgically treated with a face-lift (rhytidectomy); however, bleeding and hematoma are complications that surgeons seek to prevent. Objective: To compare the drainage volume and rate of hematoma in studies of rhytidectomy among those having tissue sealants and those without. Methods: This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD42022325404). We included randomized controlled trials (RCTs) that the enrolled participants undergoing rhytidectomy and used tissue sealants as the intervention. We calculated the mean and standard deviation for the drainage volume; risk ratios (RRs) were used for hematoma incidents. Results: Seven RCTs were included. The drainage volume was significantly lower in the tissue sealant group than in the control group (mean difference [MD]: -11.01, confidence interval [95% CI]: -18.39 to -3.63, p < 0.00001). As for hematomas, the incidence was also lower in the tissue sealant group (RR: 0.29, 95% CI: 0.08-0.99, p = 0.05). Conclusion: This study suggests that tissue sealants can be effective in reducing drainage volume and hematoma in face-lift; however, autologous and homologous tissue sealants can be further compared in future RCTs.

Platelet-Rich Plasma in Plastic Surgery: A Systematic Review

INTRODUCTION

Platelet-rich plasma (PRP) is gaining popularity and is applied in a variety of clinical settings. This review aims to present and evaluate available evidence regarding the use of PRP in various applications in plastic surgery.

METHODS

PubMed, Web of Science, Medline, and Embase were searched using predefined MeSH terms to identify studies concerning the application of PRP alone or in combination with fat grafting for plastic surgery. The search was limited to articles in English or German. Animal studies, in vitro studies, case reports, and case series were excluded.

RESULTS

Of 50 studies included in this review, eleven studies used PRP for reconstruction or wound treatment, eleven for cosmetic procedures, four for hand surgery, two for burn injuries, five for craniofacial disorders, and 17 as an adjuvant to fat grafting. Individual study characteristics were summarized. Considerable variation in preparation protocols and treatment strategies were observed. Even though several beneficial effects of PRP therapy were described, significance was not always demonstrated, and some studies yielded conflicting results. Efficacy of PRP was not universally proven in every field of application.

CONCLUSION

This study presents an overview of current PRP treatment options and outcomes in plastic surgery. PRP may be beneficial for some indications explored in this review; however, currently available data are insufficient and systematic evaluation is limited due to high heterogeneity in PRP preparation and treatment regimens. Further randomized controlled trials employing standardized protocols are warranted.

Regenerative and stem cell-based techniques for facial rejuvenation

This review discusses the most novel ideas and modalities being incorporated into facial rejuvenation. Recent innovative techniques include the use of regenerative stem cell techniques and regeneration supportive modalities such as nano-technology or gene therapies. This review aims to investigate approaches that are less well known and lacking established evidence in order to proactively study these techniques prior to them becoming popularized. These applications and relevant research were reviewed in the context of both surgical and non-surgical modalities in clinical practice. Future directions include the concept of "precision cosmetic medicine" utilizing gene editing and cellular therapies to tailor rejuvenation techniques based on each individual's genetic make-up and therefore needs.

Perioperative Approach to Reducing Hematoma during Rhytidectomy: What Does the Evidence Show?

BACKGROUND

Postoperative hematoma remains the most common complication in rhytidectomy, prompting surgeons to use a multitude of adjunctive measures to prevent its occurrence. The goal of this systematic review was to determine which of these measures are supported by strong evidence, and to highlight those that remain unsubstantiated and require further investigation.

METHODS

A systematic search was performed of the PubMed and Embase databases for English literature from 1975 to March of 2020 containing designated keywords, and focusing specifically on adjunctive measures aimed at preventing hematoma in rhytidectomy. The resultant articles were then systematically screened according to predefined inclusion and exclusion criteria to determine eligibility for inclusion in the study.

RESULTS

The keyword search yielded a total of 2391 articles. Title and abstract screening resulted in 103 articles that were eligible for full-text review. Ultimately, 48 articles met final inclusion criteria. The articles were categorized into their particular mode of intervention: fibrin tissue sealants, perioperative medications (anesthetics, antihypertensives, miscellaneous medications), and intraoperative maneuvers (hemostatic agents, preinfiltration, intraoperative maneuvers, and drains). Nine studies were indexed as evidence Level II and 24 as evidence Level III. The remainder of studies constituted Level IV evidence.

CONCLUSIONS

Adjunctive interventions have been borne out of necessity in efforts to reduce postoperative hematoma after rhytidectomy. Although many of these interventions have promising results, the current literature supports the senior author's (R.J.R.) experience that an evidence-based, multimodal approach is ideal to minimize the rates of hematoma after rhytidectomy.

Platlet-Rich Plasma - Review of Literature

Wound healing is a dynamic and physiological process for restoring the normal architecture and functionality of damaged tissue. Platelet-rich plasma (PRP) is an autologous whole blood product that contains a large number of platelets in a small volume of plasma with complete set of coagulation factors, which are in physiological concentrations. PRP has haemostatic, adhesive properties and acts supraphysiologically in the process of wound healing and osteogenesis. Platelets play a very important role in the wound healing process by providing growth factors that enhance the rate and quality of wound healing by many different mechanisms. The aim of this review is to describe: the biology of platelets and their role in the wound healing process, the terminology of platelet rich products, PRP preparation, activation and concentration of PRP, as well as the use of PRP in plastic surgery.

Platelet-Rich Plasma: Principles and Applications in Plastic Surgery

Platelet-rich plasma (PRP) is an autogenously harvested liquid platelet concentrate extracted from a patient's peripheral blood that contains higher than baseline concentrations of growth factors and cytokines. This innovative new technology has demonstrated great promise in the field of plastic surgery, and its use has been evaluated in several clinical settings including wound healing, hair restoration, and skin rejuvenation. The goal of this article is to explain the biology behind PRP and to review the basic principles involved in its preparation. This will be followed by a discussion of some clinical applications of PRP in both aesthetic and reconstructive plastic surgery.

Adipose-Derived Stromal Vascular Fraction Cells and Platelet-Rich Plasma: Basic and Clinical Implications for Tissue Engineering Therapies in Regenerative Surgery

Cell-based therapy and regenerative medicine offer a paradigm shift in regard to various diseases causing loss of substance or volume and tissue or organ damage. Recently, many authors have focused their attention on mesenchymal stem cells for their capacity to differentiate into many cell lineages. The most widely studied types are bone marrow mesenchymal stem cells and adipose derived stem cells (ADSCs), which display similar results. Based on the literature, we believe that the ADSCs offer advantages because of lower morbidity during the harvesting procedure. Additionally, platelet-rich plasma can be used in this field for its ability to stimulate tissue regeneration. The aim of this chapter is to describe ADSC preparation and isolation procedures, preparation of platelet-rich plasma, and the application of ADSCs in regenerative plastic surgery. We also discuss the mechanisms and future role of ADSCs in cell-based therapy and tissue engineering.

The Efficacy of Platelet-Rich Plasma in the Field of Hair Restoration and Facial Aesthetics—A Systematic Review and Meta-analysis

As a promising alternative to traditional treatment, platelet-rich plasma (PRP) is being used to encourage hair growth through the release of growth factors and cytokines. In addition to hair restoration, PRP’s multifactorial capabilities can also be used to treat aging skin, facial scarring, and acne. The purpose of this review is to critically examine the success of PRP in the field of dermatology, with specific attention to the role of PRP in hair restoration. Where possible, meta-analyses were used to evaluate the efficacy of PRP. In androgenetic alopecia (AGA) patients, 3 monthly PRP injections (1 session administered every month for 3 months) exhibited greater efficacy over placebo as measured by change in total hair density (hair/cm2) over the treatment period (mean difference: 25.61, 95% CI: 4.45 to 46.77; P = .02). The studies included in the meta-analysis used a half-head design, which may have influenced the results because of the effects PRP can induce. Controlled studies suggest that 2 to 4 sessions of PRP combined with traditional therapies and procedures can help minimize acne scarring and facial burns, improve aesthetic results, and decrease recovery time. However, data for these indications are lacking and are less robust in design. In conclusion, to achieve an improvement in hair restoration in patients with mild AGA, 3 initial monthly PRP injections should be given. Only upon completion of rigorous, randomized, controlled studies can standardized and effective PRP protocols for treating dermatology conditions such as acne scarring, facial burns, and aging skin be determined.

Regenerative Medicine in Facial Plastic and Reconstructive Surgery: A Review

The field of regenerative medicine aims at enhancing tissue healing and regeneration through the exogenous addition of therapeutic growth factors and cells, often in combination with tissue-compatible scaffolds. Perhaps the biggest advances in facial plastic and reconstructive surgery (FPRS) in the coming years will be the result of regenerative medicine techniques. While many articles on regenerative medicine have been published in the FPRS literature, to our knowledge there are no reviews that describe both soft-tissue and bony regeneration strategies, including scaffolds, stem cells, growth factors, and platelet-rich plasma. In reviewing the literature, we found that these strategies have produced very promising results and that regenerative medicine has the potential to augment conventional treatment options in the FPRS subspecialty. In the near future, these novel approaches may begin to replace autologous grafting and free tissue transfer in FPRS, the current standards of care. In this review we look at where our subspecialty is today with regard to regenerative medicine and suggest ways for future study and growth.

Effects of Platelet-Rich Plasma on Tissue Expansion in Rabbits

BACKGROUND

Tissue expansion has been widely applied in clinic practice. However, the expanded skin is always insufficient for clinical use and how to promote tissue expansion is still a challenge. Platelet-rich plasma (PRP) contains multiple tissue growth factors and has been widely utilized in hard- and soft-tissue augmentation. However, its feasibility to promote tissue expansion has not been explored. The purpose of this study was to evaluate the possible effect of PRP in tissue expansion.

METHODS

Tissue expanders were implanted in the dorsal sides of rabbit ears, and the left and right side were for the PRP group and the control group randomly. The PRP group was injected with 1.0 mL of autologous PRP in the expansion skin and the control group with the same volume of saline solution. The expanders were inflated regularly by injecting saline solution under the same pressure. After the inflation phase, the expansion skin was harvested and the inflation volume, gross specimen, and histological characteristics were assayed and evaluated.

RESULTS

The mean inflation volume of the PRP group was significantly higher than that of the control (p < 0.05). H&E staining of expanded skin sections showed more epidermal cell layers and thicker skin in the PRP group than that in the control group. There were significantly more capillaries in the expanded skin in the PRP group than those from the control group by IHC staining with its marker anti-CD31. A higher level of mRNA expression of VEGF was observed in the PRP group by real-time PCR.

CONCLUSIONS

The present study suggests that PRP plays a pivotal role in tissue expansion and skin proliferation.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .

Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review

Background

Platelet rich plasma (PRP) has attracted attention in a number of surgical fields due to a wide variety of potential clinical benefits. Yet PRP has not gained wide popularity in aesthetic surgery as a result of uncertainty surrounding objective clinical evidence.

Objectives

We aim to describe the current applications, define preparation and activation, explore effectiveness, and propose a classification system to facilitate comparisons across studies.

Methods

A comprehensive review of the literature regarding the use of platelet rich plasma in aesthetic surgery was performed. Data gathered included: PRP application, study type, subject number, centrifugation, anticoagulation, activation, PRP composition, and outcomes.

Results

Thirty-eight reports were identified. Applications included injection into aging skin (29%), scalp alopecia (26%), lipofilling (21%), fractional laser (13%), and facial surgery (11%). The majority of studies (53%) were case series without controls. Leucocytes were sparsely defined (32%). The concentration of injected and/or baseline platelets was rarely clarified (18%). The mechanism of activation was described in 27 studies (71%), while anticoagulation was uncommonly elucidated (47%). While most studies (95%) claim effectiveness, objective measures were only utilized in 17 studies (47%).

Conclusions

Current studies produce context-dependent results with a lack of consistent reporting of PRP preparation, composition, and activation in aesthetic applications, making meaningful meta-analysis unrealistic. Thus the method of PRP preparation warrants increased attention. We recommend a set of descriptors, FIT PAAW (described below), to produce scientifically grounded conclusions, facilitating a clearer understanding of the situations in which PRP is effective.

Level of Evidence

4

Platelet-rich Plasma and Incidence of Alveolar Osteitis in High-risk Patients Undergoing Extractions of Mandibular Molars: A Case-control Study

Background

To evaluate the efficiency of platelet-rich plasma (PRP) on the incidence of alveolar osteitis (AO) in patients with potential risk factors for the development of AO.

Materials and Methods

This study was conducted in 150 patients visiting the outpatient department of oral and maxillofacial surgery. Patients with potential risk factors for the development of AO which included smokers, alcoholics, postmenopausal women, patients on oral contraceptives, pericoronitis, and bruxism were included for the study. Patients were randomly divided into two groups. Group A consisted of 75 patients in which PRP was placed in the socket after extraction. Group B consisted of 75 patients in which sockets were left for normal healing without the placement of PRP. The patients were assessed for pain and dry socket on the 3^rd and 5^th postoperative day.

Results

All the local signs and symptoms of inflammation were mild to moderate and subsided in normal course of time. Pain was less in Group A where the extraction sockets were treated with PRP. Soft-tissue healing was also statistically significant on the PRP treated site when compared to the other group where PRP was not placed into the socket after extraction. The incidence of AO among the patients who have the potential risk factor for the development of the same was significantly reduced in Group A.

Conclusion

The study showed that autologous PRP is a biocompatible material and has significantly improved the process of soft-tissue healing, reduced pain, and decreased the incidence of AO in the extraction socket when treated with PRP.

Platelet-Rich Plasma (PRP) Utilized to Promote Greater Graft Volume Retention in Autologous Fat Grafting

Objectives:

Autologous fat theoretically provides one of the most ideal mediums for soft-tissue augmentation and reconstruction, although its clinical applications have been marked with skepticism because of its documented unreliable survival. Over the years, numerous unsuccessful efforts have set forth to elucidate modifications in the application process of autologous fat grafts to allow the medium greater clinical predictability. This study aims to investigate the effects of platelet-rich plasma (PRP) on autologous fat grafts when used in conjunction with each other in soft tissue augmentation and reconstruction.

Study Design:

Retrospective review, over a 30-month period, of consecutive patients with results greater than 6 months in duration.

Methods:

This study is based on clinical experiences representing 2033 grafts in 448 consecutive patients using PRP additives and in the previous 132 patients who had syringe harvest without use of PRP. All PRP isolates were harvested via the Smart Prep system. Harvest and augmentation techniques are discussed and representative results are presented.

Results:

Results were based on clinical observations and patient satisfaction. Of the 580 patients in the experimental group, essentially all showed greater graft volume retention over extended time intervals compared with control subjects (nongraft areas). Patients in the PRP-added experimental group displayed less postoperative ecchymosis and edema, which also led to greater patient satisfaction in this group.

Conclusion:

Adding PRP to autologous fat aids in graft volume retention and survival when used clinically for soft-tissue augmentation and reconstruction.

Efficacy of Autologous Platelet-rich Plasma Glue in Weight Loss Sequelae Surgery and Breast Reduction: A Prospective Study

Background:

Seroma and hematoma formations are the most common complications after plastic surgery. The aim of this study was to assess the efficacy of autologous platelet-rich plasma (A-PRP) glue to reduce postoperative wound complications and improve surgical outcomes.

Methods:

Fifty-four patients were included in this study. They underwent breast reduction surgery, abdominoplasty, or limb lifting with A-PRP glue application on the entire surface of the subcutaneous tissue at the time of suture. Retrospective data were used for the control group. The primary endpoint was the incidence of postoperative seroma or hematoma. The secondary endpoint was the Patient and Observer Scar Assessment Scale score.

Results:

Demographics and clinical characteristics were not statistically different between the A-PRP glue group and the control group regarding age, sex ratio, and body mass index. After abdominoplasty, 37.5% of patients (3/8) in the control group experienced seroma and hematoma complications versus 12.5% of patients (2/16) in the A-PRP glue group (P = 0.55 and P = 0.25, respectively). After limb lifting, 50% of patients experienced postoperative complications in the control group versus no patient in the A-PRP glue group (P = 0.03*; * indicates that the P value is significant). After breast reduction, no patient experienced complication in the A-PRP glue group versus 25% of patients in the control group who experienced hematoma (P = 0.04*). The scar quality assessed 12 months after surgery showed no statistical differences between the groups.

Conclusions:

A-PRP glue seems effective to prevent seroma formation after limb lifting and hematoma formation after breast reduction. Wound-healing quality did not seem to be improved.

Concise Review: The Use of Adipose-Derived Stromal Vascular Fraction Cells and Platelet Rich Plasma in Regenerative Plastic Surgery

Tissue engineering has emerged at the intersection of numerous disciplines to meet a global clinical need for technologies to promote the regeneration of tissues. Recently, many authors have focused their attention on mesenchymal stem/stromal cells (MSCs) for their capacity to differentiate into many cell lineages. The most widely studied cell types are bone marrow mesenchymal stem cells and adipose-derived stem cells (ASCs), which display similar results. Biomaterials, cells, and growth factors are needed to design a regenerative plastic surgery approach in the treatment of organ and tissue defects, but not all tissues are created equal. The aim of this article is to describe the advances in tissue engineering through the use of ASCs, platelet rich plasma, and biomaterials to enable regeneration of damaged complex tissue. Stem Cells 2017;35:117-134.

Platelet Preparations for Use in Facial Rejuvenation and Wound Healing: A Critical Review of Current Literature

In facial plastic surgery, the potential for direct delivery of growth factors from platelet preparations has been of particular interest for use in facial rejuvenation, recovery after facial surgery, and wound healing. A literature search was conducted through PubMed for the terms PRP, PRFM, platelet-rich plasma, platelet-rich fibrin matrix, platelet preparations, platelet therapy, growth factors, platelet facial, platelet facial rejuvenation, platelet wound healing, platelet plastic surgery. Articles pertaining to the use of platelet preparations in facial surgery and wound healing in plastic surgery after 2001 were included. Thirteen in vitro studies showed use of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) had a significant effect on cellular activity. Twenty-four out of 28 animal studies exhibited favorable results with use of a platelet preparation, including five of six studies that showed enhanced fat graft survival with addition of a platelet preparation. Twenty-three case series and clinical trials were identified, only two of which showed no differences. Twenty-one reported favorable results with use of various platelet preparations. A total of 47 studies used PRP, four studies evaluated Leukocyte-rich PRP, and fourteen studies used PRFM. The vast majority of studies examined show a significant and measurable effect on cellular changes, wound healing, and facial esthetic outcomes with use of platelet preparations, both topical and injectable. One must also consider possible publication bias against null results that may have had an influence on the data that were available for review. However, the preponderance of studies suggests that platelet preparations might represent an as-of-yet untapped adjunct in facial plastic surgery.

Systematic review of the use of platelet-rich plasma in aesthetic dermatology

Platelet-rich plasma (PRP) is a highly concentrated autologous solution of plasma prepared from a patient's own blood. PRP contains platelets that are purported to release numerous growth factors that may be valuable in numerous dermatologic applications. Here, we review systematically the clinical cosmetic applications of PRP including: androgenetic alopecia, scar revision, acne scars, skin rejuvenation, dermal augmentation, and striae distensae to understand the potential and best practices for PRP use. A systematic search was conducted on three databases: Pubmed, Embase, and Web of Science. Publications were included if they were in English, investigated the clinical applications of PRP in aesthetic dermatology and reported clinical results either as case reports or clinical studies. There were a total of 22 manuscripts that fulfilled these criteria. Four evaluated hair-related applications, eight evaluated the treatment of scars and postprocedure recovery, eight evaluated skin rejuvenation and dermal augmentation, and two evaluated treatment of striae distensae. PRP is a relatively new treatment modality with studies suggesting its utility in aesthetic dermatology. The combination of PRP with other therapies is particularly interesting. Future studies should include controls, including incorporation of split-face comparisons, to reduce intersubject variability.

Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*

The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Perioperative Blood Management presents an updated report of the Practice Guidelines for Perioperative Blood Management.

Supplemental Digital Content is available in the text.

Mandibular Third Molar Extraction Wound Healing With and Without Platelet Rich Plasma: A Comparative Prospective Study

AIMS

To evaluate the efficacy of autologous platelet rich plasma (PRP) in regeneration of bone and to assess clinical compatibility of the material in mandibular third molar extraction socket.

OBJECTIVE OF THE STUDY

To compare the healing of mandibular third molar extraction wounds with and without PRP.

MATERIALS AND METHODS

Group A consists of the 30 patients where PRP will be placed in the extraction socket before closure of the socket. Group B consists of 30 patients who will be the control group where the extraction sockets will be closed without any intra socket medicaments. The patients would be allocated to the groups randomly.

RESULTS

Soft tissue healing was better in study site compared to control site. The result of the study shows rapid bone regeneration in the extraction socket treated with PRP when compared with the socket without PRP. Evaluation for bone blending and trabecular bone formation started earlier in PRP site compared to control, non PRP site. Also there was less postoperative discomfort on the PRP treated side.

CONCLUSION

Autologous PRP is biocompatible and has significant improved soft tissue healing, bone regeneration and increase in bone density in extraction sockets.

Considerations on the use of platelet-rich plasma, specifically for burn treatment

Platelet-rich plasma (PRP) is a fraction of blood plasma with a platelet concentration above baseline. After activation of the platelets, growth factors are released, which are involved in wound-healing processes. Application of a multitude of growth factors seems to boost the healing process. In this review the authors provide a comprehensive overview of the many different aspects of PRP; this is followed by a short outline of the evidence for a wide range of applications and finally narrowing down to a more in-depth analysis of the literature on the potential use of PRP in burn treatment. The authors performed an extensive search on PRP and the different biological, as well as practical aspects for the different applications. Furthermore, we performed a systematic search on PRP in the treatment of burn wounds. A high variety exists in PRP products, procedures, and content. This makes interpretation and comparison of the evidence difficult. PRP has been reported to have beneficial effects on wound healing in different fields of surgery and in the treatment of acute, chronic, and diabetic wounds. Literature on the use of PRP in burns is scarce. Separate growth factors have shown beneficial results in the treatment of burns. Furthermore, an animal study and several case reports showed improved burn wound-healing time after the application of PRP. A deep dermal burn could benefit from PRP through its hemostatic antimicrobial abilities and the positive effects seen in wound healing. However, burn patients have an altered physiological state and it is unknown how this may affect platelet function and quality. Furthermore, the effect of PRP on scarring has not been evaluated properly. Future research is needed to elucidate the role of PRP in the treatment of burns.

P.R.L. platelet rich lipotransfert: our experience and current state of art in the combined use of fat and PRP

The authors report their experience about the use of P.R.L. PLATELET RICH LIPOTRANSFERT method (platelet rich plasma mixed fat grafting) in 223 patients affected by soft tissue defects (ulcers, Romberg syndrome, Hemifacial atrophy, loss of substance, and signs of aging). This paper introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality, showing at the current clinical use of PRP in plastic and reconstructive surgery, with description of innovative methods and future prospects. This technique provides a promising alternative to surgery by promoting safe and natural healing. Here recent studies concerning the use of PRP in the treatment of chronic ulcers and soft tissue defect are reviewed.

The use of platelet-rich plasma in plastic surgery: a systematic review

OBJECTIVE

The study's aim was to evaluate the available evidence regarding the use of platelet-rich plasma in plastic and reconstructive surgery, through implementation of a systematic review of the literature.

DATA SOURCES

PubMed and The Cochrane Library were searched using MeSH terms: 'platelet rich plasma' and 'plastic surgery' for all publications up to July 2011. All English, German, French and Dutch papers were included. In addition, the reference lists of relevant articles were searched for potentially appropriate publications.

STUDY SELECTION

Included studies needed to report on topics related to plastic and reconstructive surgery, mentioning at least one clinical end point. Both in vivo and in vitro comparative studies, performed in humans or animals, were included. A total of 82 publications were found, of which 40 studies met the inclusion criteria and were relevant to be used in this systematic review.

DATA EXTRACTION

Data from retrieved studies were reviewed and tabulated according to year of publication, study design, human or animal studies, characteristics of the population, mode of application, outcomes and preparation method.

DATA SYNTHESIS

A total of 15 randomised controlled trials and 25 case-control studies were found. Thirty-six publications demonstrated favourable outcomes with the use of platelet-rich plasma. The included articles were divided into three topics related to plastic surgery: wound healing, fat grafting and bone grafting.

CONCLUSIONS

This systematic review describes a substantially beneficial effect of platelet-rich plasma for several indications, including a better wound healing rate, an increased survival rate of fat grafts and an enhancement of bone graft regeneration.

Platelet-rich fibrin matrix for facial plastic surgery

Platelets are known primarily for their role in hemostasis, but there is increasing interest in the effect of platelets on wound healing. Platelet isolates such as platelet-rich plasma have been advocated to enhance and accelerate wound healing. This article describes the use of a novel preparation, platelet-rich fibrin matrix (PRFM), for facial plastic surgery applications such as volume augmentation, fat transfer supplementation, and as an adjunct to open surgical procedures.

Delivery system for autologous growth factors fabricated with low-molecular-weight heparin and protamine to attenuate ischemic hind-limb loss in a mouse model

Frozen and thawed platelet-rich plasma (PRP) contains high concentrations of various growth factors, such as fibroblast growth factor (FGF)-2, vascular endothelial growth factor, and hepatocyte growth factor. We previously reported that low-molecular-weight heparin/protamine microparticles (LH/P MPs) are useful as biodegradable carriers for the controlled release of FGF-2. In this study, we examined the ability of PRP/LH/P MPs to prevent limb loss in an induced ischemic hind-limb model that used adult BALB/c-nu/nu male mice. One day after inducing ischemia, intramuscular injections of a PRP/LH/P MPs solution were administered into several sites of the ischemic hind limb. Seven days and onward after the injections, the PRP/LH/P MPs-treated and PRP-treated groups recovered from ischemia, as reflected by the improved oxygen saturation. In the PRP-treated group, however, the level of recovery of oxygen saturation after ischemia decreased after 14 days. From the 21st day onward, there was a significant difference between those two groups. In the LH/P MPs-treated group, a partial recovery occurred only in the early period. The saline-treated group (i.e., the control) and the noninjection group (i.e., ischemia only) exhibited no recovery. The limb survival rate at 1 year in the ischemia-induced mice injected with PRP/LH/P MPs was approximately 25 % (two of eight mice) but was absent in the other groups.

BLOOD-DERIVED, TISSUE ENGINEERING BIOMATERIALS

Fibrin sealant and platelet gels are human blood-derived, biodegradable, non toxic, surgical products obtained by mixing a fibrinogen concentrate or a platelet rich plasma with thrombin, respectively. Fibrin sealant is now a well known surgical tool increasingly used to stop or control bleeding, or to provide air and fluid tightness in many surgical situations. Platelet gels are newly developed preparations that are of specific interest because they contain numerous physiological growth factors and cytikines that are released upon the activation of blood platelets by thrombin. These growth factors, including PDGF, TGF-β 1, BMP, and VEGF have been shown to stimulate cell growth and differentiation with special clinical benefits for soft and bony tissue healing and regeneration. Platelet gels allow surgeons to manipulate the cellular environment of surgical sites and to guide tissue regeneration. A specific interest of such products is observed for the induction of osteogenesis and chondrogenesis. Advances in the preparation, clinical use, and safety of these two important classes of blood-derived biomaterials are reviewed.

Concise review: adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical implications for tissue engineering therapies in regenerative surgery

Cell-based therapy and regenerative medicine offer a paradigm shift in regard to various diseases causing loss of substance or volume and tissue or organ damage. Recently, many authors have focused their attention on mesenchymal stem cells for their capacity to differentiate into many cell lineages. The most widely studied types are bone marrow mesenchymal stem cells and adipose-derived stem cells (ADSCs), which display similar results. Based on the literature, we believe that the ADSCs offer advantages because of lower morbidity during the harvesting procedure. Additionally, platelet-rich plasma can be used in this field for its ability to stimulate tissue regeneration. The aims of this article are to describe ADSC preparation and isolation procedures, preparation of platelet-rich plasma, and the application of ADSCs in regenerative plastic surgery. We also discuss the mechanisms and future role of ADSCs in cell-based therapy and tissue engineering.

Enhancement of vascularization and granulation tissue formation by growth factors in human platelet-rich plasma-containing fragmin/protamine microparticles

The purpose of this study was to evaluate effects of human platelet-rich plasma (PRP)-containing fragmin/protamine microparticles (F/P MPs) as a protein carrier on neovascularization and granulation tissue formation. Frozen and thawed PRP contains high concentrations of various growth factors (GFs) and F/P MPs effectively adsorb those GFs. Human microvascular endothelial cells (MVECs) and dermal fibroblast cells (DFCs) were optimally grown in medium containing 4% PRP and the addition of F/P MPs significantly maintained and protected the proliferative activity of PRP incubated at 37°C for more than 10 days. When PRP-containing F/P MPs were subcutaneously injected into the back of mice, significant neovascularization was induced near the injected site with enhanced filtration of inflammatory cells from day 3 to day 30, compared with controls (injections of PRP, F/P MPs, and saline). Both PRP-containing F/P MPs and PRP alone induced significant formation of granulation tissue at the injected site. However, thickness of induced granulation tissues was well maintained for 30 days only in PRP-containing F/P MP-injected group. Those bound GFs may be gradually diffused and released from F/P MPs in vitro and in vivo. Thereby, PRP-containing F/P MPs offer significantly higher inductions of vascularization and fibrous tissue formation in vivo than PRP alone.

Caption: a filtration-based platelet concentration system

Despite significant advances, wound management remains a medical challenge and a major health-expense problem. Currently, a wide range of therapeutic interventions are available for wound care. This is only partially explained by the variability in the presenting clinical situation and shows that there is no panacea for this complex medical problem. Over time, a multitude of interventions have been proposed as solutions for faster and more effective healing; however, only a few are still part of the wound care armamentarium today. Based on the fact that platelets contain a high concentration of growth factors, the application of platelet-enriched plasma over wound sites was recently introduced as a novel therapeutic modality. As increasing evidence started to validate its benefit, several devices for platelet-rich plasma preparation became available. Here, we present the most recently introduced platelet concentration system and provide insights on the current and possible future applications of this treatment modality.

No positive effect of autologous platelet gel after total knee arthroplasty

BACKGROUND AND PURPOSE

Activated platelets release a cocktail of growth factors, some of which are thought to stimulate repair. We investigated whether the use of autologous platelet gel (PG) in total knee arthroplasty (TKA) would improve wound healing and knee function, and reduce blood loss and the use of analgesics.

PATIENTS AND METHODS

102 patients undergoing TKA were randomly assigned to a PG group (n = 50) or to a control (C) group (n = 52). The primary analysis was based on 73 participants (PG: 32; C: 41) with comparison of postoperative wound scores, VAS, WOMAC, knee function, use of analgesics, and the pre- and postoperative hemoglobin values after a follow-up of 3 months. 29 participants were excluded due to insufficient data.

RESULTS

The characteristics of the protocol-compliant patients were similar to those of the patients who were excluded. Analysis was per protocol and focused on the remaining 73 patients. At baseline and after 3 months of follow-up, there were no statistically significant differences between both groups regarding age, height, weight, sex, side of operation, platelet count, hemoglobin values, severity of complaints (WOMAC), and level of pain.

INTERPRETATION

In our patients undergoing TKA, application of PG to the wound site did not promote wound healing. Also, we found that PG had no effect on pain, knee function, or hemoglobin values.

Bone and wound healing augmentation with platelet-rich plasma

Over the past two decades, autologous platelets that have been sequestered, concentrated, and mixed with thrombin to generate growth factor-concentrated platelet-rich plasma for application to bone and wounds to aide healing have been a subject of great interest. This article reviews the literature related to the use of autologous platelet-rich plasma in bone and wound healing, and reviews the processes necessary to secure a high concentration of viable platelets. Although not yet definitive, autologous platelet-rich plasma has been shown to be safe, reproducible, and effective in mimicking the natural process of bone and wound healing.

Use of tissue sealants in face-lifts: a metaanalysis

BACKGROUND

This review sought to determine the efficacy of tissue sealants such as fibrin tissue adhesives and platelet-rich plasma in reducing postoperative drainage, ecchymosis, and edema after face-lift surgery.

METHODS

The electronic databases MEDLINE (1966-May 2007) and EMBASE (1974-May 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for human studies, randomized controlled trials, controlled clinical trials, metaanalyses, and reviews of randomized controlled trials using the key words "fibrin tissue adhesive," "tissue sealant," "platelet-rich plasma," "face-lift," "rhytidoplasty," "rhytidectomy," and "facial plastic surgery." The search yielded 10 articles, only 3 of which met our inclusion criteria. The three studies were within-patient comparisons (patients acted as their own controls).

RESULTS

Although not statistically significant, the pooled results showed a strong trend toward reduction in postoperative drainage at 24 h and ecchymosis with the use of tissue sealants compared with the control arm of the study. No difference in outcomes was observed between the tissue sealant and control arms of the study in terms of postoperative edema measurement.

CONCLUSION

There was no statistically significant benefit from the use of tissue sealants in face-lift surgery. However, tissue sealants may be useful for patients at a high risk for hematoma and ecchymosis formation.

Plasma rico em plaquetas de coelhos: introdução a um modelo animal experimental

RACIONAL: Muitas dúvidas ainda permanecem no que se refere às ações dos fatores de crescimento e do plasma rico em plaquetas sobre o mecanismo de reparação tissular. Há necessidade de serem esclarecidos pontos controversos ainda existentes. OBJETIVO: Obter o plasma rico em plaquetas em coelhos através de um método simplificado e ao mesmo tempo adequado, introduzindo um modelo experimental que possa ser utilizado em estudos posteriores. MÉTODOS: Foram utilizados 25 coelhas da raça Nova Zelândia e sem doenças prévias. Quinze mL de sangue de cada animal foi coletado, sendo 10 mL submetidos à dupla centrifugação. Para comprovar a efetividade do método proposto realizou-se contagem mecânica do sangue, bem como do produto final. RESULTADO: Obteve-se uma concentração média de plaquetas no plasma rico em plaquetas 687% maior que a contagem inicial observada no sangue venoso periférico. Para as variáveis: contagem inicial de plaquetas, contagem de plaquetas no plasma rico em plaquetas e enriquecimento, foram obtidos os limites de 95% de confiança para suas médias, sendo que, no que se refere ao percentual de enriquecimento, existe 95% de chance de que o intervalo de (530-844) contenha a média real de enriquecimento de plaquetas. CONCLUSÃO: O método simplificado utilizado permite a obtenção de plasma rico em plaquetas adequado permitindo seu uso em estudos dos fatores de crescimento nos mecanismos de reparação tecidual.

Efficacy and safety of the use of autologous plasma rich in platelets for tissue regeneration: a systematic review

BACKGROUND

Autologous plasma rich in platelets (PRP) is a derived blood product whose application in clinical practice is growing. A systematic review was conducted to evaluate its efficacy and safety.

STUDY DESIGN AND METHODS

A search was performed in electronic databases. Randomized controlled clinical trials (RCTs) in adult patients were included and assessed for methodologic quality. The main outcomes were "tissue regeneration" and "safety." Relative risks (RRs) and standardized mean differences (SMDs) were calculated to show pooled estimates for these outcomes. When the results heterogeneity was more than 50 percent, a sensitivity analysis was performed.

RESULTS

Twenty RCTs were included (11 of oral and maxillofacial surgery, 7 of chronic skin ulcers, and 2 of surgery wounds). Four RCTs evaluated the depth reduction in gingival recession in chronic periodontitis; the SMD was 0.54 (95% confidence interval [CI], 0.16 to 0.92) mm, favorable to PRP. Three RCTs evaluated the clinical attachment level in chronic periodontitis; the SMD was 0.33 (95% CI, -0.71 to 1.37) mm. Six RCTs assessed the complete skin epithelialization in wound ulcers; the RR was 1.40 (95% CI, 0.85 to 2.31). Only 6 RCTs reported adverse effects without differences between groups.

CONCLUSIONS

PRP improves the gingival recession but not the clinical attachment level in chronic periodontitis. In the complete healing process of chronic skin ulcers, the results are inconclusive. There are little data about PRP safety. There are several methodologic limitations and, consequently, future research should focus on strong and well-designed RCTs that assess the efficacy and safety of PRP.

The healing effects of autologous platelet gel on acute human skin wounds

OBJECTIVE

To compare the healing of full-thickness skin punch wounds treated with topical autologous platelet gel (APG) vs conventional therapy (antibiotic ointment and/or occlusive dressings) in healthy volunteers.

METHODS

A prospective, single-blind, pilot study comprising 80 full-thickness skin punch wounds (4 mm diameter) was conducted on the thighs of 8 healthy volunteers. With each subject serving as his or her own control (5 punch sites per leg), APG was applied topically on one thigh, and an antibiotic ointment and/or a semiocclusive dressing was applied on the other thigh. Healing was monitored for spontaneous wound closure by clinical assessment and by digital photographs over 6 months. Over 35 days, 64 serial dermal biopsy specimens (6 mm diameter) were analyzed (using hematoxylin-eosin, Mason trichrome, CD-34, and Ki-67 stains) to measure differences between treated and control sites for cellularity, granulation formation, vascularity, epithelialization, and cellular replication.

RESULTS

Over a 42-day period, the APG-treated sites had statistically increased wound closure compared with controls by visual clinical assessment and by digital planimetry photographic measurements (P<or=.02). On day 17, the percentage of closure was 81.1% +/- 2.5% (mean +/- SE) for the APG-treated sites and 57.2% +/- 5.9% for the control sites. Also, the APG wound closure velocities were significantly faster than those of the controls (P = .001). Histologically, over time, the APG-treated sites had similar cellularity, cellular replication, granulation tissue, vascularity, and epithelialization compared with controls. However, when the platelet count in the gel was more than 6 times the baseline intravascular platelet count in some subjects, epithelialization and granulation formation appeared 3 days earlier in the APG-treated group. Furthermore, in vitro testing of supplemental APG showed increased endothelial cell proliferation compared with controls (P<.04).

CONCLUSION

This pilot study provides preliminary evidence that topical APG may hasten wound closure in full-thickness dermal wounds in healthy individuals.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00199992.