Role of local application of autologous platelet-rich plasma in the management of pressure ulcers in spinal cord injury patients

Treatment of severe pressure ulcers with protein-enriched filtered platelet-rich plasma (PEFPRP): a possible management

Background: Biological dressings with non-transfusion blood components are among the treatments available for pressure ulcers (PUs). Biological dressings contain active concentrated pro-regenerative molecules that can modify and switch off local inflammatory pathways. This re-establishes the physiological homing, which results in healing. In our study, we used a biological component obtained by ultrafiltration of plasma-platelet concentrate: protein-enriched filtered platelet-rich plasma (PEFPRP) with a higher platelet and higher plasma protein concentration. We tested whether treatment with PEFPRP could improve healing in advanced-stage pressure ulcers with a large surface area. All the patients in this study had a surgical indication but were not able to undergo surgery for various reasons. Materials and methods: Ten patients with severe neurological disability and advanced-stage sacral pressure ulcers were treated with allogenic PEFPRP. The mean lesion surface area at T0 was 13.4 cm2 ( ± 9.8 SD). PEFPRP was derived from allogenic plasma-platelet apheresis that had been pre-ultrafiltered with a ProSmart™ filter (Medica, Italy) to obtain a concentration after filtration of the plasma protein (12-16 g/dL) and platelet (1-1.2 x 106 microL). Results and Conclusion: All cases showed a reduction in the surface area of the pressure ulcer and in the Pressure Ulcer Scale for Healing (PUSH) score. The mean reduction values at week 6 were as follows: -52% for surface area and -21% for PUSH. Rapid wound healing is fundamental to avoid infections and improve patients' quality of life. This blood component builds new tissue by creating a new extracellular matrix. This, in turn, promotes rapid restoration of the three-dimensional structure of the tissue necessary for healing deeper wounds. PEFPRP shrinks the PU and improves its morphological features (reducing undermining and boosting granulation tissue). PEFPRP also promotes tissue restoration, obtaining an optimal scar. It is a safe and feasible treatment, and these preliminary results support the use of PEFPRP in the treatment of pressure ulcers. PEFPRP dressings could be integrated in the standard treatment of advanced-stage PU.

The use of platelet-rich plasma in wound healing and vitiligo: A systematic review and meta-analysis

OBJECTIVE

To critically assess the effect and safety of platelet-rich plasma (PRP) in chronic wounds and vitiligo.

METHODS

A systematic literature searching was performed. Results were expressed as weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies.

RESULTS

A total of 27 studies were included in this meta-analysis. In patients with chronic diabetic ulcers, PRP significantly increased proportion of complete wound healing, percentage of wound area healed, and shortened the complete wound healing. In venous ulcers, PRP improved the epithelialized area and percentage of wound area healed. In vitiligo, PRP had better results in degree of improvement and mean repigmentation than controls. Regarding the safety profile, PRP did not increase the risk of infection in patients with chronic diabetic ulcers. Meta-regression revealed that source of PRP and preparation method of PRP significantly affected the proportion of complete wound healing, whereas age, gender, country, duration of wound, and wound size had no impact on this outcome.

CONCLUSION

PRP is effective and safe, and can be used as a potential therapeutic adjunct or alternative treatment in chronic wounds of multiple etiologies and vitiligo.

Autologous blood clots: a natural biomaterial for wound healing

Repair after injury in mammalian tissue involves a complex cascade of events, with the formation of local blood clots being essential for the initial phases of wound healing. As a result, emerging research has sought to harness this biological activity to generate a pro-regenerative biomaterial to speed up wound healing. According to recent studies, “blood clots” created in vitro can be employed as an orthobiologic-based biomaterial for promoting tissue regeneration. Even though such research is still in its early phases, numerous studies show encouraging results that suggest autologous blood clots created in vitro might be a valuable treatment for soft tissue and orthopedic injuries. In this article, we discuss the function of blood clots in physiologic healing, how exogenous material can affect this process, and the most recent clinical research that proposes the use of autologous blood clots as a therapeutically beneficial biomaterial.

Application of platelet-rich plasma in spinal surgery

With the aging of the population and changes in lifestyle, the incidence of spine-related diseases is increasing, which has become a major global public health problem; this results in a huge economic burden on the family and society. Spinal diseases and complications can lead to loss of motor, sensory, and autonomic functions. Therefore, it is necessary to identify effective treatment strategies. Currently, the treatment of spine-related diseases includes conservative, surgical, and minimally invasive interventional therapies. However, these treatment methods have several drawbacks such as drug tolerance and dependence, adjacent spondylosis, secondary surgery, infection, nerve injury, dural rupture, nonunion, and pseudoarthrosis. Further, it is more challenging to promote the regeneration of the interstitial disc and restore its biomechanical properties. Therefore, clinicians urgently need to identify methods that can limit disease progression or cure diseases at the etiological level. Platelet-rich plasma (PRP), a platelet-rich form of plasma extracted from venous blood, is a blood-derived product. Alpha granules contain a large number of cytokines, such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor, platelet factor 4 (PF-4), insulin-like growth factor-1 (IGF-1), and transforming growth factor-β (TGF-β). These growth factors allow stem cell proliferation and angiogenesis, promote bone regeneration, improve the local microenvironment, and enhance tissue regeneration capacity and functional recovery. This review describes the application of PRP in the treatment of spine-related diseases and discusses the clinical application of PRP in spinal surgery.

"Platelet-Rich Fibrin Membrane-as a novel biomaterial for pressure injury healing in a person with spinal cord injury: A case report"

INTRODUCTION

Pressure injury (PI) impacts the quality of life, and socioeconomic and psychological well-being negatively in persons with Spinal Cord Injury (SCI). Autologous Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) showed promising roles in wound healing. PRF is considered a second-generation PRP, contains more growth factors and is more biocompatible than PRP. It possesses an additional favourable impact on wound healing due to its three-dimensional fibrin architecture, and antimicrobial property. There are no studies on PRF membrane use for PI healing in SCI.

CASE PRESENTATION

A 25-year-old male with operated traumatic T10 American Spinal Injury Association Impairment Scale grade A paraplegia with neurogenic bowel, and bladder and a stage II PI over the left greater trochanter, was admitted for inpatient rehabilitation. The chronic non-healing PI which did not show any improvement following normal saline (0.9%) dressing for the past 3 months, was treated with autologous PRF membrane weekly for four weeks. The PI healed completely and no adverse events were noted. Weekly total scores of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool and Pressure Ulcer Scale for Healing were 6, 6, 5, 2, 0 and 12, 10, 10, 3, and 0 respectively.

DISCUSSION

To the best of our knowledge, this is the first case report on the healing of PI in SCI with the use of PRF. This novel biomaterial is a safe and effective promising agent for PI management in SCI. But further randomized trials are needed to establish stronger evidence regarding feasibility and effectiveness.

Applications of the regenerative capacity of platelets in modern medicine

Platelets produce platelet growth factors such as PDGF, IGF-1, EGF-, HGF, TGFβ, bFGF, and VEGF, which are crucial in regulating all stages of the wound healing process. The source of these substances is platelet-rich plasma (PRP). Over the past five decades, the interest and use of the regenerative properties of platelets have increased significantly in many different fields of medicine around the world. PRP and PRF plate preparations are used in: 1. Dentistry (they reduce bleeding, facilitate and accelerate soft tissue healing and bone regeneration - FGF 2, IGF-1, IGF-2, TGF-β1, and PDGF); 2. Sports medicine - IGF-1, IGF-2, TGF-β, VEGF, PDGF and bFGF, EGF); 3. dermatology and cosmetology (treatment of alopecia, hair reconstruction - FGF-7, HGF, acne scars, skin rejuvenation and regeneration, treatment of chronic and poorly healing wounds, burns, and acquired vitiligo); 4. Gynecology and reproductive medicine (treatment of infertility, erectile dysfunction - PDGF-β, TGF-β, IGF-1, in sexual dysfunction - PDGF, in vaginal atrophy); 5 Ophthalmology (in the healing of corneal epithelial wounds, in the treatment of dormant corneal ulcers, dry eye syndrome and the reconstruction of the corneal surface; 6. Neurology (regeneration of neurons, pain alleviation, and clinical symptoms - TGF-β 1, IGF-1, PDGF, VEGF) and FGF). Platelet-rich plasma therapy is a very interesting alternative and complement to traditional methods of treatment. However, the potential for using platelets is still not fully understood. The composition of platelet-rich plasma depends on many factors that may affect its use's efficacy and clinical benefits. Further research is necessary to standardize PRP delivery's preparation procedures and methods for a specific disease entity or clinical case.

Efficacy of Local Autologous Platelet-Rich Plasma in the Treatment of Pressure Ulcer in Spinal Cord Injury Patients

BACKGROUND

Pressure ulcer is one of the common complications occurring in spinal cord injury (SCI) patients. Platelet-rich plasma (PRP) has been found useful in the treatment of pressure ulcers in few studies. The purpose of this study was to evaluate the role of PRP in pressure ulcer healing in comparison to hydrogel dressing in SCI patients.

METHODS

In this randomized interventional study, 52 patients of SCI having pressure ulcers of grade III/IV were randomized into two groups of 26 each. In group A patients, hydrogel dressing was done while freshly prepared PRP was used in patients of group B. Pressure ulcers were evaluated at baseline and after three weeks and six weeks in terms of ulcer surface area, volume, Pressure Ulcer Scale for Healing (PUSH) score, histopathology, and ulcer healing parameters. Data were collected and quantitative variables were compared using unpaired t-test or Mann-Whitney test between the two groups and qualitative variables were compared using the chi-square test or Fisher's exact test. A p-value of <0.05 was considered statistically significant.

RESULTS

 Baseline characteristics were comparable in both groups. There was a significant improvement in ulcers in terms of surface area, volume, and PUSH score in both the groups but it was comparable (p-value >0.05). There was a significant improvement in the PRP group as compared to the other group in terms of epithelization, granulation, and neovascularization at three and six-week follow-up.

CONCLUSIONS

This study suggests that PRP is a possible and better alternative to conventional dressing methods for the treatment of pressure ulcers.

The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds: A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the effectiveness and adverse events of autologous platelet-rich plasma (PRP) in individuals with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers.

PATIENTS AND METHODS

We searched multiple databases from database inception to June 11, 2020, for randomized controlled trials and observational studies that compared PRP to any other wound care without PRP in adults with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers.

RESULTS

We included 20 randomized controlled trials and five observational studies. Compared with management without PRP, PRP therapy significantly increased complete wound closure in lower-extremity diabetic ulcers (relative risk, 1.20; 95% CI, 1.09 to 1.32, moderate strength of evidence [SOE]), shortened time to complete wound closure, and reduced wound area and depth (low SOE). No significant changes were found in terms of wound infection, amputation, wound recurrence, or hospitalization. In patients with lower-extremity venous ulcers or pressure ulcers, the SOE was insufficient to estimate an effect on critical outcomes, such as complete wound closure or time to complete wound closure. There was no statistically significant difference in adverse events.

CONCLUSION

Autologous PRP may increase complete wound closure, shorten healing time, and reduce wound size in individuals with lower-extremity diabetic ulcers. The evidence is insufficient to estimate an effect on wound healing in individuals with lower-extremity venous ulcers or pressure ulcers.

TRIAL REGISTRATION

PROSPERO Identifier: CRD42020172817.

Platelet-Rich Plasma Content of Active Spinal Cord Injured Patients: A Controlled Laboratory Study

OBJECTIVE

Platelet-rich plasma has potential uses for patients with spinal cord injuries. However, no study has quantified the cellular and growth factor content of platelet-rich plasma in this population. This study aimed to analyze (1) platelet-rich plasma content of spinal cord injury subjects and (2) the effect of high-intensity interval exercise on their platelet-rich plasma.

DESIGN

Ten spinal cord injury patients and 10 controls were enrolled. At rest, platelet-rich plasma was created from both groups. The spinal cord injury group then performed high-intensity interval exercise and underwent a second blood draw to create post-high-intensity interval exercise platelet-rich plasma. Complete blood counts and growth factor analysis (via enzyme-linked immunosorbent assay) was performed on all platelet-rich plasma.

RESULTS

The spinal cord injury group had lower platelets (305,700 ± 85,697/μl vs 380,800 ± 57,301/μl, P = 0.015) and transforming growth factor β (12.84 ± 1.58 vs 14.33 ± 0.63 ng/ml, P = 0.023). Four minutes of high-intensity interval exercise increased the platelets (305,700 ± 85,697/μl to 399,200 ± 96,251/μl, P = 0.004), leukocytes (906 ± 930 vs 2504 ± 3765/μl, P = 0.002) and transforming growth factor β (12.84 ± 1.58 to 14.28 ± 1.21 ng/ml, P = 0.020).

CONCLUSIONS

Spinal cord injury patients have fewer platelets and transforming growth factor β in their platelet-rich plasma at baseline compared with controls. Exercise increased platelet, leukocyte, and transforming growth factor β yield, compensating for the baseline deficits.

Eliminating non-healing wounds: a review

Non-healing cutaneous wounds, including pressure, diabetic and venous ulcers, are wounds where the skin and underlying tissues die due to ischemia, infection, metabolic conditions, immunosuppression or radiation. Some can be eliminated with relatively straightforward techniques, although they may continue to grow in diameter and depth, becoming increasingly painful and never heal. Others respond more slowly or poorly to treatment, while others are recalcitrant to treatments. This review examines the etiology of non-healing wounds and different wound management treatments. In addition, it examines the efficacy of platelet-rich plasma in promoting wound healing and its potential mechanisms of action. It is concluded that platelet-rich plasma alone, but more effectively when combined with another technique(s), has the greatest potential for promoting complete wound healing. However, further studies are required to determine whether the efficacy of wound healing induced by each of these techniques is enhanced by applying the techniques simultaneously.

Comparison of platelet-rich plasma gel in the care of the pressure ulcers with the dressing with serum physiology in terms of healing process and dressing costs

This research was carried out with the aim of comparing the effects of platelet-rich plasma (PRP) gel and gas dressing with serum physiologic applied to stage II pressure ulcer in coccyx of patients for 2 months on healing process and dressing costs. This prospective randomised controlled experimental study was conducted with 60 patients hospitalised in the palliative care unit after surgery. The experimental group (n = 30) was dressed with platelet-rich plasma gel. The control group (n = 30) was treated with serum physiologic dressing. At the end of the 20th observation of the patients in the experimental group, it was found that the mean scores of area, exudate, and tissue type in pressure sores decreased statistically (P < .001). In the control group, no significant difference was found between the mean PUSH score at the end of the 20th observation (P > .05). The study showed that PRP gel had a positive effect on healing of stage II pressure ulcers with platelet-rich plasma gel dressings. In addition, when evaluated in the long term, it was concluded that platelet-rich plasma gel is easily accessible and less costly than serum physiological dressing.

Cost-effectiveness of Platelet-Rich Plasma for Diabetic Foot Ulcer in Spain

This study evaluated the cost-effectiveness of platelet-rich plasma (PRP) added to usual care versus usual care alone in elderly patients with chronic diabetic foot ulcer (DFU) from the Spanish health care system perpective. A 6-state Markov model with 3-month cycles was used to estimate costs and outcomes of wound healing and risk of recurrences, infections, and amputations over 5 years. Three treatment strategies were compared: (a) usual care plus PRP obtained with a commercial kit, (b) usual care plus PRP obtained manually, and (c) usual care. Data on effectiveness were taken from a recent meta-analysis. Outcomes and costs were discounted at 3% and resources were valued in 2018 euro. Compared with usual care, the PRP treatment with the manual method was more effective and less costly (dominant option), whereas the PRP treatment with the commercial kit was more effective but also more costly, with the incremental ratio being above the cost-effectiveness threshold (€57 916 per quality-adjusted life year). These results are sensitive to the price of PRP kits (a 20% discount would make the PRP treatment a cost-effective option) and effectiveness data, due to the heterogeneity of primary studies. In conclusion, PRP treatment for DFUs could be considered a cost-effective or even cost-saving alternative in Spain, depending on the method of obtaining the PRP. Despite the dominance of the manual method, its general use is limited to hospitals and specialized centers, whereas PRP kits could be used in primary care settings, but their prices should be negotiated by health authorities.

Platelet-derived bio-products: Classification update, applications, concerns and new perspectives

Platelet derived bio-products in the form of platelet rich plasma, plasma rich in growth factors, or plasma-free platelet releasates, are being studied worldwide with the aim of proving their efficacy in tissue regeneration within many different clinical areas, such as traumatology, maxillofacial surgery, ophthalmology, dermatology and otorhinolaryngology, amongst others. The current lack of consensus in the preparation method and application form, or in the quality assessment of each bio-product, precludes adequate interpretation of the relevance of reported clinical outcomes, and, while many in clinicians are very positive about them, many are sceptic. Relevant aspects of these products are considered to propose a classification nomenclature which would aid a comprehensive comparison of clinical outcomes of bio-products of the same characteristics. Finally, the uses of platelet-derived bio-products in in vitro culture (for cell therapy purposes) as a substitute of animal-origin sera, and other future perspectives of applications of platelet-derived bio-products are discussed.

Synergistic Effects of Human Platelet-Rich Plasma Combined with Adipose-Derived Stem Cells on Healing in a Mouse Pressure Injury Model

Pressure injury (PI) affects quality of life and results in economic and social burdens. Local transplantation of human adipose-derived stem cells (ASCs) is considered an effective treatment. However, ASC suspension alone is vulnerable to the immune system and results in a shortened cell survival. There is increasing evidence of a synergistic effect of platelet-rich plasma (PRP) combined with ASCs on wound healing. This study investigated the effectiveness, synergy, and mechanism of wound healing following local injection of PRP combined with ASCs in a rodent PI model. PRP or ASCs alone were the control intervention. Wound healing, inflammatory infiltration, collagen deposition, angiogenesis, neurogenesis, and cell homing were investigated. PI healing was promoted by the synergistic effects of PRP combined with ASCs. The combination was more effective than ASCs alone for modulating inflammation, increasing collagen deposition, angiogenesis, neurogenesis, and the persistence of the injected ASCs. These data provide a theoretical foundation for the clinical administration of ASCs combined with PRP in PI healing and skin regeneration.

Platelet-rich plasma and its utility in medical dermatology: A systematic review

The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma (PRP), recently garnering significant interest in alopecia, acne scarring, and skin rejuvenation. In other conditions of dermatology, such as chronic wounds and vitiligo, PRP has been investigated but has received less attention. The objective of this literature review was to focus on conditions of medical dermatology and to consolidate the available evidence on PRP for the practicing dermatologist. This review evaluates the literature up to October 31, 2018, and a search was conducted in the PubMed database for "platelet-rich plasma," "platelet releasate," "platelet gel," "platelet-rich fibrin" or "PRP" and "dermatology," "skin," "cutaneous," "wound," or "ulcer." In total, 14 articles met the inclusion criteria for this review. In studies representing Levels of Evidence 1b-4 according to the Centre for Evidence-Based Medicine, Oxford, PRP significantly improved wound healing in chronic diabetic ulcers, venous ulcers, pressure ulcers, leprosy ulcers, acute traumatic wounds, and ulcers of multifactorial etiologies. Two studies also documented benefits of adjunctive PRP in stable vitiligo. In chronic wounds of multiple etiologies and vitiligo, PRP warrants further investigation because it represents a potential therapeutic adjunct or alternative with a favorable side effect profile.

[Effect of human adipose-derived stem cells on pressure ulcer healing in mouse]

Objective

To investigate the effect of human adipose-derived stem cells (hADSCs) on pressure ulcers in mouse.

Methods

The subcutaneous adipose tissue from voluntary donation was harvested. Then the hADSCs were isolated and cultured by mechanical isolation combined with typeⅠcollagenase digestion. The 3rd generation cells were identified by osteogenic, adipogenic, chondrogenic differentiations and flow cytometry. The platelet rich plasma (PRP) from peripheral blood donated by healthy volunteers was prepared by centrifugation. The pressure ulcer model was established in 45 C57BL/6 mice by two magnets pressurized the back skin, and randomly divided into 3 groups ( n=15). The wounds were injected with 100 μL of hADSCs (1×10 ⁶ cells) transfected with a green fluorescent protein (GFP)-carrying virus, 100 μL human PRP, and 100 μL PBS in hADSCs group, PRP group, and control group, respectively. The wound healing was observed after injection. The wound healing rate was calculated on the 5th, 9th, and 13th days. On the 5th, 11th, and 21st day, the specimens were stained with HE staing, Masson staining, and CD31 and S100 immunohistochemical staining to observe the vascular and nerve regeneration of the wound. In hADSCs group, fluorescence tracer method was used to observe the colonization and survival of the cells on the 11th day.

Results

The cultured cells were identified as hADSCs by induced differentiation and flow cytometry. The platelet counting was significantly higher in PRP group than in normal peripheral blood group ( t=5.781, P=0.029). General observation showed that the wound healing in hADSCs group was superior to those in PRP group and control group after injection. On the 5th, 9th, and 13th days, the wound healing rate in hADSCs group was significantly higher than those in PRP group and control group ( P<0.05). Histological observation showed that compared with PRP group and control group, inflammatory cell infiltration and inflammatory reaction were significantly reduced in hADSCs group, collagen deposition was significantly increased, and skin appendage regeneration was seen on the 21st day; at each time point, the expression of collagen was significantly higher in hADSCs group than in PRP group and control group ( P<0.05). Immunohistochemical staining showed that the number of neovascularization and the percentage of S100-positive cells in hADSCs group were significantly better than those in PRP group and control group on the 5th, 9th, and 13th days ( P<0.05). Fluorescent tracer method showed that the hADSCs could colonize the wound and survive during 11 days after injection.

Conclusion

Local transplantation of hADSCs can accelerate healing of pressure ulcer wounds in mice and improve healing quality by promoting revascularization and nerve regeneration.

Biological approach for the management of non-healing diabetic foot ulcers

OBJECTIVE

To show an approach to profit of the main components of platelet rich plasma (PRP), i.e. the signaling proteins, and the fibrin scaffold and discuss the intervention within TIME (Tissue, Inflammation/Infection, Moisture, Edges) framework.

METHODS

Two patients with diabetic foot ulcers are treated with both liquid and gelled PRP, and the rationale for the PRP intervention is described herein. Autologous blood is withdrawn and, PRP is separated by single spinning and activated with CaCl2 prior to application. PRP is injected in an activated liquid form, i.e. freshly activated, before coagulation, within the wound edges. In fibrotic tissue PRP is introduced performing a needling procedure. In addition, PRP, clotted ex-vivo, is applied in the wound bed as a primary dressing.

RESULTS

Both patients responded positively to PRP intervention. Case 1 healed after five weekly PRP applications. Case 2 healed after eight weekly PRP applications. Patient satisfaction was high in both cases. The procedure had no complications, is well tolerated and easy to perform in any medical setting.

CONCLUSION

PRP intervention is safe and if associated with correct tissue debridement and preparation of the host tissue it may help to decrease the burden of diabetic foot ulcers. Carefully designed randomized clinical trials with special attention to the PRP procedure are needed to assess the efficacy of these interventions.

To Evaluate Antimicrobial Properties of Platelet Rich Plasma and Source of Colonization in Pressure Ulcers in Spinal Injury Patients

Background. Exposure of pressure ulcers (PrUs), particularly to urine and feces, leads to increased colonization of wounds. The aim of the present study was to evaluate the source of microbial colonization and antimicrobial properties of autologous platelet rich plasma (PRP) in controlling it in PrUs. Methods. Twenty-five patients of spinal cord injury (SCI) with at least two PrUs were taken for the study. Local application of autologous PRP on one PrU (case) was compared with saline dressing on the other PrU (control). Urine cultures, urethral meatus, PrUs, and perineal swabs were taken at weekly interval for five weeks. Result. Colonization rate of PrUs (case) decreased from 92% at enrollment to 24% at the 5th week but did not significantly decrease in PrUs (control) from enrollment (84%) to the 5th week (76%). Association between PrU (case) and perineal cultures was observed for Staphylococcus aureus at enrollment 41% (χ2=6.76, P<0.01) and at the 2nd week 47% (χ2=5.83, P<0.05). 47% association between PrU (control) and perineal cultures at enrollment (χ2=4.11, P<0.05) and 29% association at the 2nd week (χ2=8.41, P<0.01) were observed for Staphylococcus aureus. There was association between bacteria present in perineum/urine and those colonizing PrUs. Conclusion. There is a significant association between PrUs colonization and bacteria present in local environment (urine and feces). Local application of autologous PRP changes the “biological milieu” of the PrUs through its antimicrobial properties leading to reduction in bacterial colonization.