The Effectiveness of Autologous Platelet Rich Plasma Application in the Wound Bed Prior to Resurfacing with Split Thickness Skin Graft vs. Conventional Mechanical Fixation Using Sutures and Staples

Platelet-rich plasma and plasma rich in growth factors in extra-oral wound care

This narrative review evaluates the existing literature on the clinical efficacy and safety of platelet-rich plasma (PRP) and plasma rich in growth factors (PRGFs) in extra-oral wound care, considering their potential benefits and drawbacks. The review specifically focuses on the impact of these treatments on patients' quality of life, pain management, treatment costs, recurrence rates, and potential complications. Given the extensive literature and diverse range of extra-oral wound types in which these autologous platelet concentrates have been applied, this narrative review focuses on the most frequently described wound types, including diabetic foot ulcers, venous leg ulcers, pressure ulcers, surgical wounds, and burns. The use of PRP has been reported in various medical specialties, with a low risk of adverse events. While there is a growing interest in the use of PRGF with promising results, the available literature on this topic is still limited. Only a few studies evaluated patients' perception of the treatment and the relationship between treatment costs and clinical outcomes. Data on recurrence rates and complications also vary across studies. In conclusion, PRP and PRGF show promise as alternatives or as adjunctive therapies to conventional treatments for various extra-oral wounds and ulcers, leading to reduced wound size and accelerated healing time but should be considered on a case-by-case basis, taking into account the type and severity of the wound.

The Application of Blood Products in Plastic Surgery: A Systematic Review

Background

Due to their minimal trauma and relative safety, blood products are becoming increasingly popular in medical aesthetics. In recent years, research on the application of blood products has also been increased. This article will summarize the research progress of emerging blood products in plastic surgery in recent years.

Methods

We searched the PubMed database for literature related to the application of blood preparation in plastic surgery over the past 5 years and summarized them.

Results

Commonly used in plastic surgery are platelet-rich plasma, platelet-rich fibrin, concentrated growth factor, platelet-poor plasma, and mesenchymal stem cells derived from blood products. They can be used for wound repair and skin and autologous fat transplantation, and can be combined with laser therapy and facial rejuvenation.

Conclusions

Understanding the application pathways of blood products in plastic surgery and their respective advantages and disadvantages can help us better choose and use them.

An Outcome Analysis of Fibrin Sealant versus Staples for Fixation of Split-Thickness Skin Grafts

Background  Skin grafting plays a vital role in post-burn and post-traumatic wound management. Split-thickness skin grafts (STSG) are traditionally fixed using staples or sutures, which have tedious application and their removal necessitates painkillers, medical equipment, and human intervention. As an alternative, fibrin sealant is a biological tissue adhesive, composed of thrombin, calcium, and fibrinogen. Fibrin sealant promotes hemostasis and acts as a biological adherent. Objective  The aim of this study was to evaluate the outcomes (graft take, wound healing and complications) of fibrin sealant and staples for STSG fixation. Methods  It is a randomized controlled trial on 40 patients with wounds of minimum 400 cm 2 . Wound area was divided into equal halves and randomly allocated to the study group or control group. In the study group, 4 mL per 200 cm 2 of fibrin sealant was sprayed followed by STSG application. In the control group, STSG was fixed with only skin staples. Evaluation was done on postoperative days 3, 5, 15, and 30 for graft take, hematoma/seroma, infection, and complete wound healing. Results  The mean graft take was significantly higher ( p -value < 0.05) in the study group than in the control group (91 vs. 89%). No seroma or hematoma formation was seen in either group. Complete wound healing was seen in more patients in the study group, but the difference was statistically insignificant. Conclusion  Fibrin sealant is an excellent alternative to staples for skin grafting, with the advantage of better graft take and being free of pain that is incurred during staple removal.

Efficacy of platelet-rich plasma in alleviating split skin graft morbidities

Introduction

Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors.

Aims and Objectives

To assess the effect of PRP on split-thickness skin graft uptake and donor site healing.

Materials and Methods

In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group.

Results

Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing.

Conclusion

The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.

Role for platelet rich plasma as an adjuvant therapy in wound healing and burns

Background

Platelet rich plasma (PRP) contains high concentrations of growth factors. Intuitively, these were thought to be of potential benefit in healing of chronic wounds, skin grafts and graft donor sites. This was echoed in retrospective studies and an individual case basis but had not been randomized.

Methods

A systematic search was carried out by two individuals, independently, on the MEDLINE, EMBASE and COCHRANE databases, according to PRISMA guidelines. All data analysis and statistics was pooled and analysed using the Cochrane RevMan Software.

Results

Split thickness grafts have been described by numerous authors, but PRP use did not offer a significant advantage in graft take in pooled results (MD 5.83, 95% CI − 0.69 to 12.25, random-effects, p = 0.08). The analysis of included randomized controlled trials has shown favourable split-thickness skin graft donor site healing in the PRP group (MD − 5.55, 95% CI − 7.40 to − 3.69, random-effects, p =  < 0.00001) compared to the control group. For carpal tunnel syndrome, the pooled results showed no difference in functional scores vs steroid injections (SMD − 0.68, 95% CI − 1.47 to 0.10, randomeffects, p = 0.09) or indeed splinting groups.

Conclusions

With the current body of evidence, we conclude that the use of PRP as an adjuvant therapy in skin grafts, burns, carpal tunnel surgery or scars cannot be rationalised. A potential use of PRP is in donor site management but the cost of this would be difficult to justify.

Level of evidence: Not ratable.

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.

Efficacy of Platelet-Rich Plasma in Reduction of Post-Operative Split-Thickness Skin Graft Loss and Hematoma Formation: A Meta-Analysis

Split-thickness skin grafting is a very popular technique of wound closure, especially for large wounds. The success rate of a split-thickness skin graft (STSG) has consistently been in the range of 70-90%. Multiple techniques have been introduced to further improve graft survival, for example, the use of autologous platelet-rich plasma (PRP), thrombin gel, platelet-rich fibrin matrix, and negative pressure wound therapy. We evaluated the impact of PRP use on the survival of STSG through a meta-analysis. We conducted the analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol and performed a literature search using the following databases: PubMed, Cochrane, and ClinicalTrials.gov. A total of 126 articles were yielded by the search, out of which four randomized controlled trials (RCTs) were included according to our eligibility criteria and irrelevant articles were excluded. The intervention group received PRP application to the wound bed before applying the graft while the control group received treatment with conventional fixation procedures (sutures and staples). We estimated the pooled odds ratio with a 95% confidence interval (CI). The total number of participants in the analysis was 460. The participants had wounds of varying etiology. Post-operative graft loss and hematoma formation were taken to be the primary and secondary outcome measures, respectively. Thirty-four participants suffered graft loss of differing extent in the control group while three participants suffered graft loss in the intervention group. The pooled odds ratio for graft loss was 0.15 (95% CI: 0.05-0.49; I²=38%; p=0.184) signifying that PRP use decreased the odds of graft loss by 85%. For our secondary outcome measure, 440 participants were studied. Forty-four participants suffered hematoma formation in the control group versus 11 in the intervention group. The pooled odds ratio for hematoma formation was calculated as 0.21 (95% CI: 0.09-0.50; I²=0%; p=0.869) signifying that PRP use decreased the odds of hematoma formation by 79%. PRP appears to significantly impact graft survival, and further studies are needed to strengthen the evidence base for its use in split-thickness skin grafting.

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.

Assisted therapy with platelet-rich plasma for burn patients: A meta-analysis and systematic review

INTRODUCTION

Platelet-rich plasma (PRP) therapy has been used in different medical fields, but its effectiveness in burn wound healing remains debatable. In this study, we performed a systematic review and meta-analysis of the available evidence on burn patients treated with PRP to evaluate the safety and efficacy of the treatment.

METHODS

Randomized controlled trials evaluating the efficacy of PRP in patients with burn injuries were selected. Eligible retrospective studies were abstracted and assessed for the risk of bias by two reviewers and results of mean time to complete epithelization and wound closure rate in the included studies were analyzed. Studies on the correlation between PRP and burn wound healing published in English or Chinese before March 2020 were retrieved from PubMed.

RESULTS

Eight studies (including 449 patients) met our inclusion criteria. Qualitative analysis revealed that compared with the control group, the PRP group had significantly better wound closure rates at weeks 2 (mean difference (MD): 12.79 [95% confidence interval (CI): 7.08, 18.49]; I2: 0%; p < 0.0001) and 3 (MD: 12.66 [95% CI: 5.97, 19.34]; I2: 55%; p = 0.0002) and time to complete epithelialization (MD: -3.45 [95% CI: -4.87, -2.04] (days); I2: 0%; p < 0.00001). There was no significant difference in infection rate or graft take rate.

CONCLUSIONS

PRP application can accelerate wound closure, however, it has no effect on the rates of wound infection and graft take rate.

The Adjunct Use of Platelet-Rich Plasma in Split-Thickness Skin Grafts: A Systematic Review

OBJECTIVE

To summarize the available literature on platelet-rich plasma (PRP) as an adjunct to split-thickness skin graft (STSG) in an organized and easy-to-read format. These data may encourage surgeons to integrate PRP into their skin graft protocol.

DATA SOURCES

The authors conducted a systematic search using the PubMed, Cochrane, and ClinicalTrials.gov databases for articles published from their respective inceptions to October 1, 2019, to identify relevant studies.

STUDY SELECTION

A total of 629 articles were reviewed, and 5 were identified for inclusion in this study. The population of all studies was patients receiving an STSG to close a skin defect.

DATA EXTRACTION

Articles were screened for the following outcome measures: graft take rates, edema or hematoma formation, instant adhesion of graft, healing time, length of hospital stay, scar hypertrophy, and frequency of dressing changes.

DATA SYNTHESIS

The data were organized into two tables describing the studies and the selected outcome measures.

CONCLUSIONS

The data suggest that PRP in STSG reduces healing time, length of hospital stay, and scarring and that it eliminates the need for sutures/staples. Further, these benefits may correlate with a decrease in overall expenditure. This systematic review suggests that further research on PRP and skin grafts is warranted.

Coaxial nanofiber scaffold with super-active platelet lysate to accelerate the repair of bone defects

To develop biocomposite materials with the local sustained-release function of biological factors to promote bone defect repair, coaxial electrospinning technology was performed to prepare a coaxial nanofiber scaffold with super-active platelet lysate (sPL), containing gelatin/PCL/PLLA. The nanofibers exhibited a uniform bead-free round morphology, observed by a scanning electron microscope (SEM), and the core/shell structure was confirmed by a transmission electron microscope (TEM). A mixture of polycaprolactone and sPL encapsulated by hydrophilic gelatin and hydrophobic l-polylactic acid can continuously release bioactive factors for up to 40 days. Encapsulation of sPL resulted in enhanced cell adhesion and proliferation, and sPL loading can increase the osteogenesis of osteoblasts. Besides, in vivo studies demonstrated that sPL-loaded biocomposites promoted the repair of skull defects in rats. Therefore, these results indicate that core-shell nanofibers loaded with sPL can add enormous potential to the clinical application of this scaffold in bone tissue engineering.

The application of platelet-rich plasma for skin graft enrichment: A meta-analysis

Existing evidence demonstrated that the role of platelet-rich plasma (PRP) in skin graft enrichment is uncertain. The aim of this study was to evaluate the efficacy and safety of PRP for skin graft. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomised controlled trials that compared outcomes of skin graft treated with PRP versus those treated with blank controls. The outcomes mainly included the rate of skin graft take, number of skin graft loss and haematoma formation, and complications. There were 11 studies involving a total of 910 cases of skin grafts. Compared with the control group, PRP group had a significantly higher rate of skin graft take (mean difference = 5.47%; 95% confidence interval [CI], 2.80%-8.14%; P < .0001), fewer number of skin graft loss (risk ratio [RR] = 0.26; 95% CI, 0.13-0.55; P = .0004) and fewer cases of haematoma formation (RR = 0.24; 95% CI, 0.11-0.54; P = .0006). There was no significant difference in the incidence of complications between two groups. This meta-analysis summarises current evidence and indicates that PRP is a safe and effective adjuvant for skin graft enrichment.