Safety and Efficacy of Autologous Platelet-rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial

Platelet rich fibrin and commercial sealants for dural closure in neurosurgery: An in vitro study

BACKGROUND

Watertight closure of the dura mater is essential after neurosurgical interventions to avoid complications such meningitis, intracranial hypotension and surgical site infections. In addition to conventional suturing techniques, various biomaterials have been proposed as sealants to minimize the risk of leakage. We previously reported that patient derived platelet-rich fibrin (PRF), an autologous biomaterial, significantly improves watertight dural closure when applied as an onlay over a standard running suture. To demonstrate the efficacy of this method, we aimed to compare this orthobiological approach with other commercially available sealants.

METHODS

We utilized an in vitro testing device that allowed for the assessment of watertight dura mater closure via hydrostatic testing. On our testing phantom using freshly harvested bovine dura maters, a standardized 20-mm incision was closed using a running suture, and the leak pressure was measured initially without (primary leak pressure) and subsequently with on lay augmentation (secondary leak pressure) using either PRF, fibrinogen- and thrombin-coated collagen patch (TachoSil®), collagen matrix graft (DuraGen®), Polyethylenglykol (PEG) and polyethylene glycol ester and trilysine amine hydrogel solution (DuraSeal®), polyethylene glycol, protein-reactive polyethylene glycol monomer coated collagen matrix (Hemopatch®) or polyethylenimine component autospray sealant (Adherus®).

RESULTS

The outcomes demonstrate that the usage of a dural onlay in addition to the standard running suture exhibited a substantial improvement in leak pressure compared to the running suture alone. Specifically, the median leak pressure was improved by 3.5 times, where the combined approach was able to withstand 38 cm H2O, whereas the running suture alone had a median leak pressure of 11 cm H2O. Upon evaluating the performance of the sealants, we identified two categories of dural sealants: a medium performance group (30 ± 2 cm H2O) comprised of Adherus® (31 cm H2O), DuraGen® (31 cm H2O), and Hemopatch® (28 cm H2O), and a high-performance group composed of DuraSeal® (45.5 cm H2O), and TachoSil® (41 cm H2O). Patient-derived PRF was able to withstand a max pressure of 45 cm H2O, falling into the high-performance group. Of all the sealants tested in this study, the PRF based patch demonstrated the lowest variance in leak pressure among all the tested sealants.

CONCLUSIONS

Autologous platelet-rich fibrin in a two-step procedure displayed enhanced augmentation and reinforced watertight closure of the dura mater, exhibiting a four-fold increase in leak pressure compared to standard running suture alone. Among other commonly utilized commercial sealants, it ranked second with demonstrated consistency in its performance.

Postoperative Infection in Myringoplasty: Impact of Surgical Technique and Timing of Infection

OBJECTIVE

We analyzed ear-related factors contributing to postoperative infections after myringoplasty. We also examined the association between the timing of postoperative infections and graft success.

MATERIALS AND METHODS

This retrospective study reviewed clinical data and operative records of patients with chronic tympanic membrane (TM) perforations who underwent myringoplasty. Factors influencing postoperative infection, including surgical techniques, perforation size, external auditory canal (EAC) packing, prophylactic antibiotic type, and the application of topical antibiotic cream, were assessed. In addition, the relationship between the timing of postoperative infection and graft failure was evaluated. Postoperative infection time was categorized as 1, 2, 3, or 4 weeks postoperatively.

RESULTS

In total, 263 patients with chronic TM perforations underwent myringoplasty. The overall postoperative infection rate was 12.2% (32/263). The modified over-underlay approach was associated with a postoperative infection rate of 19.0%, in contrast to 11.1% for the conventional over-underlay technique and 8.9% for the underlay technique (P = .081). No significant differences in postoperative infection rates were identified among the NasoPore packing group (10.9%), the erythromycin cream group (19.4%), and the no-packing group (11.9%) (P = .418). Similarly, no significant differences were observed between prophylactic antibiotic type (11.2% vs 12.2% vs 25.0%, P = .373) or between the patients with and without topical antibiotic ointment (12.4% vs 10.3%, P = .986). Among the 32 patients with postoperative infections, 21.9% achieved graft success, whereas 78.1% experienced graft failure. Graft success rates were 71.4% (5/7), 9.1% (2/22), and 0.0% (0/3) at 1, 2, and 3 weeks postoperatively, respectively (P < .01).

CONCLUSIONS

Our findings suggest that prophylactic antibiotic type, perforation size, the use of topical erythromycin cream, and EAC packing do not significantly influence postoperative infection. However, the surgical technique may affect the risk of postoperative infection. In addition, the timing of postoperative infection may influence graft failure.

L-PRF in extra-oral wound care

Leukocyte- and platelet-rich fibrin (L-PRF), a by-product of centrifuged autologous whole blood, contains high concentrations of platelets, leukocytes, and fibrin (the latter spontaneously creating a strong 3-D network (a membrane)). L-PRF membranes possess several characteristics essential in wound healing, including a barrier function, an antibacterial and analgesic activity, and the release of growth factors enhancing tissue regeneration and neo-vasculogenesis. This review investigated the role of L-PRF in treating non-responding chronic wounds such as diabetic foot, venous leg ulcers, pressure ulcers, complex wounds, leprosy ulcers (Hansen's Disease), and other demanding wounds. Chronic wounds affect millions worldwide, negatively impacting their quality of life, productivity, and life expectancy while incurring high treatment costs for themselves and private and public health systems. L-PRF has demonstrated clear adjunctive advantages in treating chronic skin wounds, shortening the time to complete wound closure, and improving patient-reported outcome measures (including reducing pain and minimizing the need for analgesics). Also, in other demanding wounds, L-PRF facilitates healing. To help clinicians, this article also proposes recommendations for the use of L-PRF in the treatment of extra-oral wounds.

Platelet Concentrates Impact on Myringoplasty Outcomes in Chronic Otitis Media Patients: Systematic Review and Meta-analysis

OBJECTIVE

We aimed to perform a systematic review and meta-analysis of myringoplasty outcomes following platelet concentrates application in patients with chronic otitis media (COM).

DATA SOURCES

We searched MEDLINE, Embase, and Cochrane Central register of Controlled Clinical Trials (CENTRAL). We also performed a manual search in Google Scholar and reference lists.

REVIEW METHODS

Eligible for inclusion were randomized controlled trials on COM patients undergoing myringoplasty with platelet concentrates (platelet-rich plasma or platelet-rich fibrin) compared to myringoplasty alone. The primary outcomes were graft uptake and air-bone gap (ABG) gain, while the secondary outcome was complication rate. We used odds ratio (OR) and standardized mean difference (SMD) to represent dichotomous and continuous outcomes, respectively.

RESULTS

Thirteen trials (n = 1179) were deemed eligible. Platelet concentrates significantly improved graft uptake after 6 months (OR: 2.45, 95% confidence interval [CI]: 1.34-4.47, P = .004, I2 = 0%, high certainty), ABG gain (SMD: 0.36, 95% CI: 0.17-0.55, P = .0002, I2 = 0%, moderate certainty), and complication rate (OR: 0.38, 95% CI: 0.18-0.82, P = .01, I2 = 0%, low certainty).

CONCLUSION

Our results showed that platelet concentrates may improve graft uptake and ABG gain and reduce complications in COM patients undergoing myringoplasty. Caution is warranted given to the relatively small sample size, as well as inconsistent reporting across included trials.

Platelet rich fibrin augmented tympanoplasty versus cartilage tympanoplasty: a randomized clinical trial

OBJECTIVES

The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations.

METHODS

This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared.

RESULTS

Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported.

CONCLUSION

Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts.

Utilization and efficacy of platelet-rich plasma and platelet-rich fibrin in otolaryngology: a systematic evidence-based review

PURPOSE

To explore utilization and efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in different sub-specialties of otolaryngology.

METHODS

A systematic search was performed using Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Medline, Clinicaltrials.gov, Scopus, and Google Scholar up to March 2024. English language randomized controlled trials with original data evaluating the use of PRP and PRF in various surgical and non-surgical procedures related to otolaryngologic sub-specialties. Dataset was limited to randomized controlled trials (RCTs) to have the best quality of evidence and possible recommendation.

RESULTS

Our database search resulted in 591 manuscripts. Four hundred twenty-six studies were primarily excluded after reviewing the title and abstract. The remaining 165 articles were studied completely, and 51 articles met the inclusion criteria. All the studies were RCTs and dated from 2001 to 2024. They included 19 studies related to otology, 10 studies related to rhinology, 7 studies related to facial plastic surgery, 6 studies related to head and neck surgery, 3 studies related to general otolaryngology, 3 studies related to pediatrics, 2 studies related to laryngology, and 1 study related to sleep medicine.

CONCLUSION

PRP and PRF are safe, easy to use, and potentially effective treatment options for multiple otolaryngology pathologies. As an autologous material, there is no risk of immune reaction, and thus has been selected as a viable treatment option by many otolaryngologists. Larger studies would be helpful to confirm efficacy and allow for optimized patient selection for this treatment option.

Advancement in Tympanic Membrane Repair: Exploring the Potential of Platelet Rich Fibrin

To assess the effectiveness of the autologous plasma-rich fibrin plug technique for repairing small tympanic membrane perforations. Platelet rich fibrin (PRF) is also called second generation platelet rich plasma due to its high amount of growth factors which could be used in tympanic perforation closure. Being autologous, it is readily available with no immunogenic reactions. PRF membrane has a strong elastin fibrin structure containing growth factors and hence can be considered as an ideal sealing material or an adjuvant to the graft in repairing tympanic membrane perforations. Ours is a prospective study. A total of 52 patients with dry small tympanic membrane perforation were included in the study. In this technique, 10 ml of blood is withdrawn from the patient, processed in a centrifuge machine, and platelet-rich fibrin (PRF) is separated from the mixture for use in the repair of small tympanic membrane defects. Out of the 52 patients, 42 experienced successful repair (full closure) of the tympanic membrane. The mean time of closure of the perforation was around 2 weeks. However, five of them encountered failure. Although the size of the perforation decreased compared to the preoperative size. Additionally, two patients developed granulations on the tympanic membrane. No major side effects were noted. Autologous PRF is a product derived from whole blood through the process of centrifugation. It is safe and effective in promoting the natural process of wound healing by incorporating a high concentration of platelet-derived growth factors as well as fibrin into the graft mixture. This facilitates the rapid healing of tympanic membrane perforation.

Platelet Rich Fibrin Graft in Myringoplasty: Pitfalls and Challenges

Autologous Platelet-rich fibrin (PRF) is an amalgam of fibrin mesh, platelets and growth factors that favour wound healing. It can be easily used as a graft material in myringoplasty, making it a promising, easy to harvest and cost effective alternative compared to cartilage or fascia graft used in conventional myringoplasty. 50 patients of small to medium, dry central perforation underwent myringoplasty using PRF graft (Group 1). Results were compared to 50 patients with similar small to medium perforations who underwent conventional transcanal myringoplasty using temporalis fascia graft (Group 2): Outcome of surgery was measured by closure of perforation and improvement in hearing at 3 months. In group 1, overall closure rate was 70% while in group 2 it was 96%. For both small and medium perforations healing was significantly higher in group 2 compared to group 1, (100% vs 87.5%) for small perforations and (95.45% vs 66.67%) for medium perforations. Hearing gain was comparable in both groups in patients in whom healing of perforation occurred. PRF stands as a suitable graft material for closure of small perforations, but, lack of rigidity and early disintegration of the graft makes it less suitable for larger perforations compared to other conventional grafts such as temporalis fascia.

Platelet-Rich Fibrin in Otorhinolaryngology

Background: Platelet-rich fibrin is a second-generation platelet concentrate. It is rich in platelets, cytokines, growth factors and leukocytes. Compared to platelet-rich plasma, it releases growth factors for a more extended amount of time. Methods:A literature review was conducted on the applications of platelet-rich fibrin in otolaryngology. Only articles written in English were further considered for the study; all others were excluded. Also, articles relating to oral and maxillofacial surgery were removed. Results: Twenty-five studies were deemed appropriate for inclusion in the present review. Conclusion:Based on the current data, platelet-rich fibrin appears to be a safe, healing-promoting material. It is a cost-effective, autologous material with enormous therapeutic application potential in the future. However, further clinical research is required before conclusive conclusions can be drawn about its usefulness.

Plasma-Rich Fibrin-Regenerative Material in Tympanic Membrane Surgery

Background and Objectives: Platelet-rich fibrin (PRF) membrane plays an important role in cell proliferation and aids in healing. This study aimed to assess the safety and efficacy of the addition of PRF to the graft in tympanoplasty. Materials and Methods: A retrospective study was conducted involving 47 patients with chronic dry eardrum perforation, who were candidates for different types of tympanoplasty (type I-IV). The study took place in the ENT department, County Emergency Clinical Hospital of Cluj-Napoca. In group 1 (27 patients) tympanoplasty was performed with a cartilage graft, while in group 2 (20 patients) a cartilage graft was used with the addition of a PRF membrane. The PRF clot was extracted and transformed into a thin membrane. Postoperative evaluation included otoendoscopy and otomicroscopy at 1, 3, 6, and 12 months after surgery, as well as pure-tone audiometry at 12 months. Results: Postoperative follow-up at 1, 3, 6, and 12 months showed a higher rate of graft survival in the PRF group than in the non-PRF group. At the 12-month mark, a successful outcome was observed in 95.0% of patients in the PRF group, while the success rate in group 1 was 70.4% (p < 0.05). The postoperative hearing threshold value was statistically significantly lower in the group with PRF, compared to the non-PRF group, being 18.4 ± 10.4 dB and 27.6 ± 16.2 dB (p < 0.001), respectively. Although the postoperative air-bone gap value did not differ significantly between groups, there was a greater improvement in the PRF group (p < 0.7). The PRF was well tolerated, and the incisions healed perfectly. Conclusions: The PRF membrane increases the rate of autograft survival and is therefore an effective material for patients with chronic perforations of the tympanic membrane.

Impact of titanium-prepared platelet-rich fibrin in type 1 fascia graft tympanoplasty on graft survival and hearing outcomes

Background

Type 1 fascia graft tympanoplasty (T1FGT) is the mainstay surgical approach for the treatment of tympanic membrane perforations. The most widely used graft material is temporal muscle fascia, and graft take rates are reported differently. The methods to enhance graft take are still being investigated. Aim: The aim of our study was to investigate the effect of titanium-prepared platelet-rich fibrin (T-PRF) on graft take and hearing outcomes in T1FGT.

Materials and Methods

Fifty-seven ears eligible for T1FGT were involved in the study and prospectively evaluated. T-PRF was applied with T1FGT in 27 ears. Thirty ears in the other group underwent only T1FGT. The patients underwent an otomicroscopic and audiometric examination in preoperative and postoperative 2nd week, 1st month, and 6th month. Both groups were evaluated in terms of hearing levels, infection, and graft take rates.

Results

Two patients in the T1FGT + T-PRF group and seven patients in the T1FGT group had postoperative perforation (graft take rate: 92.6% versus 76.7%). The graft take rate was found to be increased in the T-PRF group although the difference was not statistically significant. In the T1FGT group, the percentage of infection was higher than in the T1FGT + T-PRF group. When the preoperative and postoperative 6th-month audiometry was compared, a statistically significant hearing gain was obtained for both groups.

Conclusion

In the treatment of tympanic membrane perforations, T-PRF applied over the fascia graft was shown to increase graft take rates and decrease the probability of infection. Further studies with larger samples are needed to demonstrate the effects of PRF.

A Randomised Controlled Trial on the Efficacy of Topical Application of Autologous Platelet Rich Plasma (PRP) on Graft Uptake Rate in Adults Undergoing Type 1 Tympanoplasty for Inactive COM Mucosal Disease

To assess the efficacy of topical use of autologous platelet rich plasma (PRP) as a packing material in type 1 tympanoplasty in Mucosal Inactive COM disease by conducting a Randomized Controlled Trial in 80 patients. Prospective Randomized Controlled Trial. Total 80 patients were enrolled for the study after fulfilling the inclusion and exclusion criterion. Written and informed consent was taken from all patients. After taking detailed clinical history, the patients were divided in to two groups of 40 patients each by block randomization. Group A was the interventional group where topical autologous platelet rich plasma was applied on the graft during type1 tympanoplasty. In Group B, PRP not applied. Graft uptake rate was observed postoperatively after 1 month and 6 months. Successful graft uptake at 1st month was noted in 97.5% patients in Group A and 92.5% in Group B with a corresponding failure rate of 2.5% and 7.5% respectively. Successful graft uptake at 6th month was noted in 95% patients in Group A and 90% in Group B with a corresponding failure rate of 5% and 10% respectively. As observed from our study status of graft uptake and reperforations at 1st and 6th months subsequent to surgery and rate of post-operative infections were similar in both the groups irrespective of the status of receiving autologous platelet rich plasma. Trial registration Trial registered with CTRI (Clinical Trial Registry -India) (Reg. no CTRI/2019/02/017468 dated 05/02/2019).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03681-w.

Evaluation of the use of autologous platelet-rich fibrin in myringoplasty operation

Background

Platelet-rich fibrin (PRF) which is considered a second-generation platelet-rich plasma having a high content of growth factors could be implied as a sealant and adjuvant to grafting materials during tympanoplasty operation. This work aimed to evaluate the role of autologous platelet-rich fibrin as an adjuvant in type 1 tympanoplasty (myringoplasty) for the closure of central tympanic membrane perforations. A prospective comparative study was conducted including one-hundred patients with chronic suppurative otitis media with dry central TM perforations. The patients were classified into two equal groups: group A (case group) was subjected to myringoplasty operation with the use of autologous PRF added to the temporalis fascia graft, and group B (control group) was subjected to myringoplasty operation using graft only without PRF. Both groups were assessed for successful closure of perforation defined as an intact eardrum, success in terms of hearing defined as closure of air-bone gap down to 10 dB or lesser, and hearing gain at 6 months postoperatively.

Results

At 6 months postoperatively, the success rate (graft taking) in group A (90%) was significantly higher than in group B (70%). Success in terms of air-bone gap closure (< 10 dB) revealed that in group A, success was achieved in 39 patients (78%), which was significantly higher than in group B 27 patients (54 %). Air-bone gap at 6 months postoperatively was more in the graft taken cases in the case group than in the control group with a significant difference. There was a nonsignificant correlation between graft uptake and either hemoglobin or platelet concentrations in both groups. In addition, there was a nonsignificant correlation between graft uptake and the size of the perforation in both groups.

Conclusion

Platelet-rich fibrin is a cheap, cost-effective, and completely autologous platelet concentrate with enriched growth factors. It improves the overall success rate of myringoplasty with no noticeable side effects.

3D printing technology and applied materials in eardrum regeneration

Tympanic membrane perforation is a common condition in clinical otolaryngology. Although some eardrum patients can self-heal, a long period of non-healing perforation leads to persistent otitis media, conductive deafness, and poor quality of life. Tympanic membrane repair with autologous materials requires a second incision, and the sampling site may get infected. It is challenging to repair tympanic membranes while maintaining high functionality, safety, affordability, and aesthetics. 3D bioprinting can be used to fabricate tissue patches with materials, factors, and cells in a design manner. This paper reviews 3D printing technology that is being used widely in recent years to construct eardrum stents and the utilized applied materials for tympanic membrane repair. The paper begins with an introduction of the physiological structure of the tympanic membrane, briefly reviews the current clinical method thereafter, highlights the recent 3D printing-related strategies in tympanic membrane repair, describes the materials and cells that might play an important role in 3D printing, and finally provides a perspective of this field.

The Effect of Platelet-Rich Fibrin and Hyaluronic Acid on Perforation of Nasal Septum

BACKGROUND

Conservative approaches and surgical methods have been tried for the treatment of nasal septum perforations (NSPs), but a satisfactory method has not yet been determined.

OBJECTIVE

Our study aimed to investigate the effect of platelet-rich fibrin (PRF) and hyaluronic acid (HA) in repairing NSPs, which were experimentally created in rabbit septum.

METHODS

A total of 36 white New Zealand rabbits were included in the study. Perforations measuring 0.7 × 0.7 cm were created in their nasal septa. No additional intervention was made to the control group, which was the first group. For the second, third, and fourth groups, respectively, HA, PRF, and HA + PRF were used in the NSP region. Macroscopic and histopathological evaluations were performed after 40 days.

RESULTS

In the first group, closure was observed in none of the rabbits' NSPs. In the second group, 6 rabbits (66.7%) had full closure in their NSPs. In the third group, the NSP of 6 rabbits (66.7%) was completely closed. In the fourth group, the NSP of 7 rabbits (77.8%) had full closure.

CONCLUSION

Statistically significant closure was achieved with PRF and/or HA in rabbits in which NSP was established. These materials can be used to increase the likelihood of perforations closing.

Does intraoperative ciprofloxacin-soaked gelfoam have adverse effects on graft success rate? A randomized, double-blind controlled trial

OBJECTIVES

The aim of this study was to evaluate whether intraoperative ciprofloxacin-soaked gelfoam is safe in tympanoplasty or not.

METHOD

In this randomized, double-blind controlled clinical study, we included 100 patients between 18 and 60 years old, having perforation ≥50% of the tympanic membrane and dry ear for at least 2 months who were a candidate for underlay tympanoplasty via postauricular approach. We used ciprofloxacin soaked gelfoam in the case group and betamethasone soaked gelfoam in the control group for packing the middle ear cavity and external auditory canal during their operation. The graft success rate and tympanogram after 6 months follow-up period was considered as the primary outcome. Also, we evaluated the postoperative hearing results 6 months after the surgery as the secondary outcomes.

RESULTS

Postoperative microscopic otoscopy showed a graft success rate of 100% (44/44) and 97.7% (42/43) in the case and control groups, respectively. The level of improvement between the two groups was not significant for air-bone gap (ciprofloxacin: 9.01 ± 7.89 dB, betamethasone 5.31 ± 10.53 dB, P = .160), and speech reception thresholds (SRT; ciprofloxacin: 10.23 ± 8.62 dB, betamethasone 7.33 ± 12.60 dB, P = .260). 93.2% of all the ears in the case group and 81.4% of those in the control group achieved postoperative air-bone gap within 20 dB, but the difference between them was not significant (P = .118).

CONCLUSIONS

We found that the application of ciprofloxacin impregnated gelfoam in the middle ear, and the external auditory canal had no adverse effect on the graft success rate in tympanoplasty.

LEVELS OF EVIDENCE

1b.

The effect of platelet-rich fibrin (PRF) on wound healing, adhesion, and hemostasis after endoscopic sinus surgery in patients with nasal polyposis

PURPOSE

Chronic rhinosinusitis (CRS) is one of the most common chronic diseases seen worldwide. Endoscopic sinus surgery (ESS) has become a widely accepted procedure for medically refractory chronic rhinosinusitis and nasal polyps. Prevention of revision surgery often depends on good wound healing and less adhesion formation. In recent years, the effects of platelet-rich fibrin (PRF) on tissue healing have been addressed in many surgical branches, especially for dental implant surgery and plastic surgery.

METHODS

This prospective study was conducted with 50 patients who underwent endoscopic sinus surgery for the diagnosis of nasal polyposis. While the middle meatus in one nasal cavity was filled with PRF and supported with Nasopore, only Nasopore was used in the other nasal cavity middle meatus. The patients were followed up clinically at weeks 1, 2, 3, 4, 8, and 12 postoperatively. The assessor determined the presence of adhesion, crusting, bleeding, frontal ostium stenosis, granulation, and infection, and if present, the grades of these complications were scored according to a questionnaire.

RESULTS

In our study, adhesion, infection, bleeding, granulation, and frontal ostium stenosis were less common in the PRF group, and a statistically significant difference was found between the groups.

CONCLUSION

In our study, better results were obtained in terms of adhesion, infection, bleeding, granulation, and frontal ostium stenosis after ESS as a result of the effects of PRF on wound healing. The application of PRF is an inexpensive and easy procedure. PRF can be a good alternative to other types of tampons after ESS.

Tympanic membrane regeneration using platelet-rich fibrin: a systematic review and meta-analysis

PURPOSE

Platelet-rich fibrin (PRF) results in satisfactory wound healing. This analysis focuses on assessing the effectiveness of PRF in the treatment of tympanic membrane (TM) perforations.

MATERIALS AND METHODS

The literature was searched using PubMed, Embase, Cochrane Library and Web of Science databases from inception to February 28th, 2021. The following healing and hearing outcomes were measured: closure rate, pre-and postoperative auditory results, and incidence of postoperative infections. Data were pooled and expressed as the odds ratio (OR).

RESULTS

Ten studies were eligible for qualitative review, and seven of them were included for the final quantitative comparison. The OR for the closure rate of acute perforations was 4.30 (95% CI 1.35-13.70, I² = 0%), and the OR in the chronic subgroup was 5.42 (95% CI 2.57-11.43, I² = 0%). The total OR value for the completed closure rate was 5.10 (95% CI 2.72-9.54, I² = 0%), indicating that the utilization of PRF can enhance the closure of both acute and chronic perforations. The qualitative review did not find improved hearing results with the use of PRF. In addition to promoting closure, PRF can reduce the incidence of infections (OR = 0.14). The sensitivity analysis did not change the final results, and there was no publication bias in this analysis.

CONCLUSION

PRF can increase the closure rate of acute perforations, enhance the survival rate of autografts in TM surgeries and reduce the incidence of infections. However, the literature indicates that PRF does not influence the hearing outcomes. This study shows that PRF is an effective agent for TM regeneration.

Efficacy of Platelet Rich Fibrin in Myringoplasty

Objective

To determine the efficacy of usage of topical autologous platelet rich fibrin (PRF) in improving outcomes of myringoplasty regarding graft uptake and hearing improvement.

Methods

This study was conducted in the ENT department of Holy Family Hospital, Rawalpindi, over a period of six months from August 2019 to January 2020. It was designed as a prospective single blinded randomized controlled trial. The study involved a total of 50 participants in whom myringoplasty was done through post auricular approach using underlay technique. In 25 patients topical drops of PRF were used. Outcomes were compared after three months with the control group (n=25), who underwent myringoplasty without PRF.

Results

After three months follow-up, graft uptake was reported 78% and 52% in cases and controls, respectively (P=0.070). Mean hearing improvement was 18 dB and 6 dB in cases and controls, respectively (P=0.014). Postoperative infection occurred in 8% of the cases, and in 32% controls (P=0.037).

Conclusion

Topical use of Platelet-Rich Fibrin during myringoplasty results in improved graft uptake. Hence, resulting in much improved hearing, significant reduction in infection rates and decrease in perforation sizes.

Novel Use of Platelet Rich Fibrin Membrane in Transcanal Myringoplasty: A Prospective Study

Being rich in growth factors platelet rich fibrin (PRF) has been used for decades for its healing properties in cosmetic surgeries but its use in transcanal myringoplasty is a novel approach that remains unexplored. In todays era of minimally invasive surgery not only does it provide as a great alternative to conventional myringoplasty but also outshines it. It reduces post operative pain, hospital stay and unlike the conventional technique that uses termporalis fascia as a graft material, PRF myringoplasty if required can be reperformed on the same patient multiple times with minimal risk. This procedure comes as a boon for patients with recurrent graft defects because after multiple revision surgeries, temporalis fascia can be deficient and other graft materials like cartilage/perichondrium or fascia lata etc. have to be harvested surgically for myringoplasty. In PRF myringoplasty there is no upper limit in the number of times the PRF membrane can be made and also it does not entail any surgical incision for graft harvest. A prospective study involving 41 patients was conducted at Netaji Subhash Chandra Bose Medical College, Jabalpur where in the tympanic membrane perforations were repaired using PRF membrane with a successful outcome in 85.4% of the patients included in this study.