Elsevier

Seminars in Vascular Surgery

Volume 28, Issues 3–4, September–December 2015, Pages 195-200
Seminars in Vascular Surgery

Application of autologous platelet-rich plasma to enhance wound healing after lower limb revascularization: A case series and literature review

https://doi.org/10.1053/j.semvascsurg.2016.01.002Get rights and content

Abstract

Dermal tissue loss in patients affected by critical limb ischemia represents a serious wound-healing problem, with high morbidity, prolonged hospital stay, and high patient care costs. Treatment of ischemic foot lesions requires limb revascularization by endovascular or open surgical intervention and individualized patient-specific wound care, including antibiotic therapy; devitalized/infected wound debridement; and advanced wound dressing. In selected patients, spinal cord stimulation, vacuum-assisted closure therapy, and bioengineered tissue or skin substitutes and growth factors have been shown to improve wound healing. In this study, we present our preliminary results on topical application of autologous platelet-rich plasma to enhance the process of wound healing after revascularization of lower limbs in patients affected by critical limb ischemia.

Introduction

Critical limb ischemia (CLI) is a clinical syndrome in which patients with occlusive arterial disease of the legs experience chronic ischemic rest pain, ulcer, or gangrene [1], [2].

Foot ulcers in patients with Rutherford stage 6 lesions represent a serious problem, with high levels of morbidity, long hospital stay, and high costs. Current methods of treatment are represented by endovascular and surgical revascularization [3], [4] in association with specific antibiotic therapy for infected lesions, repeated local debridement, advanced moist wound dressing [5], [6], spinal cord stimulation [7], [8], [9], and vacuum-assisted closure therapy [10], [11].

More recently, bioengineered tissue or skin substitutes [12] and growth factors [13], [14] have been used to improve wound healing after revascularization of lower limbs.

In particular, autologous platelet-rich plasma (PRP) allows the application of large amounts of growth factors, which stimulate the production of collagen and extracellular matrix through minimum quantities of plasma.

Glycoprotein platelet-derived growth factor (PDGF) is the first growth factor to appear in the wound, starting the repair process of the connective tissue. Its most important specific activities include mitogenesis, angiogenesis, and macrophage activation [15], [16]. Growth factors promote quick increase of the number of undifferentiated mesenchymal cells at the scar site during repair and healing time. Therefore, the PRP advantage is to accelerate the regenerative process through the quantity of growth factors present in the platelets. In the present study, we report our initial experience about autologous PRP application on foot ulcers to enhance wound healing after revascularization of lower limbs, and a literature review.

Section snippets

Materials and methods

Between April and July 2015, three patients affected by Rutherford stage 6 CLI were enrolled in the present study, consisting of PRP application on foot ulcers after revascularization of the lower limbs. Patients were included in the study if the wound had a mostly clean wound bed just before product application, without local and systemic clinical signs and symptoms of active infection. Exclusion criteria were malignancy in the wound bed, current use of chemotherapy and oral corticosteroid

Results

Healing was assessed post debridement through direct ulcer tracing onto clear plastic sheet and subsequent computed planimetry, as described previously by Serra et al [17]. Ulcer size before and after revascularization (Fig. 2, Fig. 3) and PRP application are reported in Table 2 for both patients. Mean pretreatment and post-treatment ulcer area was 15.2 cm2 and 5.5 cm2, respectively. After 8 weeks, underwent ulcer area reduction was >50% patient 1, >80% in patient 2, and >66% in patient 3, with

Discussion

CLI is a clinical syndrome in which patients with occlusive arterial disease of the legs experience chronic ischemic rest pain, ulcer, or gangrene [1]. This syndrome is a severe form of peripheral arterial disease and is associated with a grave prognosis, with 1-year mortality exceeding 25% and major limb amputation rates of 30% to 50% at 1 year from diagnosis [1], [2].

Current methods of treatment are represented by endovascular and surgical revascularization in association with specific

Conclusions

Based on literature review and on our initial experience, we conclude that the use of PRP in patients affected by CLI with Rutherford stage 6 lesions constitutes a very promising adjuvant therapy to enhance the process of wound healing after revascularization. It is an organic preparation, nonimmunoreactive, nontoxic, and with low morbidity, without infections or immunologic complications, with a cost of obtaining it reasonably low.

Finally, more studies are necessary on the action mechanism and

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