Abstract
Non healing diabetic foot ulcers are a major complication in diabetics, being notoriously difficult to heal. Application of Platelet rich plasma gel (PRP), produces multiple growth factors that speed up healing.
Aims and Objectives - To evaluate the effectiveness and rate of healing of PRP gel in treatment of diabetic foot ulcers.
Materials and Methods - Thirty patients were enrolled into the study and divided into two groups - Group A (PRP group) received once weekly application of PRP gel and Group B (Control group) received saline dressings.
Observations and Results -The % reduction in ulcer surface area (80.33%) and average rate and duration of healing in PRP group was much higher than control group. The average number of dressings in the PRP group was 4.6 while the same in the control group was 64.5. Complete wound healing was seen in 14 out of 15 patients in PRP group.
Conclusion: PRP is highly effective in treatment of diabetic foot ulcers. PRP stimulates the growth of wound healing thus speeding up the duration of hospital stay. PRP is also a safe product without any allergic reactions/ infections.
Key Words: diabetic, foot, ulcer, Platelet, rich, plasma, healing.
References
1. Mayfield J. A., Reiber GE., Sanders L.J et al. “Preventive Foot Care in people with diabetes”, Diabetes Care. 2003; 26 (suppl.1): S 78.
2. International Working Group on The Diabetic Foot. International consensus on the diabetic foot and practical guidelines on the management and prevention of the diabetic foot. Brussels, Belgium: International working group on the Diabetic Foot; 2007.
3. Kathleen M, Lacci, MMSc, PA-c and Alan Dardik, “PRP –Support for Its Use in World Health”, Yale Journal of Biology and Medicine. 2010; 83(1): 1-9.
4. Ferrari M, Zia S, Valbonesi M, et al. “A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery”. International Journal of artificial Organs. 1987; 10:47-50.
5. Eppley BL, Woodell JE, Higgins J. “Platelet quantification and growth factor analysis from platelet rich plasma: implications for wound healing.” Plastic and Reconstructive Surgery, 2004; 114(6) : 1502-1508.
6. Knighton DR, Ciresi KF, Fiegel VD, Austin LL, Butler EL. “Classification andtreatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF)” Ann Surg.1986; 204 (3): 322-330.
7. Steed DL, Goslen JB, Holloway GA, Malone JM, Bunt TJ, Webster MW. “Randomized prospective double –blind trial in healing chronic diabetic foot ulcers. CT-102 activated platelet supernatant, topical versus placebo”. Diabetes Care. 1992; 15(11):1598-1604.
8. Gonshor A. “Technique for producing platelet-rich plasma and platelet concentrate: background and process”. Int J Periodontics Restorative Dent. 2002; 22(6):547–55.
9. Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Krol W, Wielkoszynski T. “Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: an in vitro study”. J Bone Joint Surg Br. 2007; 89(3):417–420.
10. Lorenzo Drago, Monica Bortolin, Christian Vassena, Silvio Taschieri, Massimo Del Fabbro “Antimicrobial activity of pure platelet –rich plasma against microorganisms isolated from oral cavity”, BMC Microbiology 2013.
11. E. J. Dougherty, “An evidence-based model comparing the cost-effectiveness of platelet-rich plasma gel to alternative therapies for patients with non -healing diabetic foot ulcers,” Advances in Skin & Wound Care, 2008; 21(12): 568–575.
12. D. J. Margolis, J. Kantor, J. Santanna, B. L. Strom, and J. A. Berlin, “Effecti-veness of platelet releasate for the treatm-ent of diabetic neuropathic foot ulcers,” Diabetes Care, 2001; 24(3): 483–488.
13. V. R. Driver, J. Hanft, C. P. Fylling, J. M. Beriou, and Autologel Diabetic Foot Ulcer Study Group, “A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers,” Ostomy/Wound Management, 2006; 52(6): 68–74.
14. D. L. Villela and V. L. C. G. Santos, “Evidence on the use of platelet-rich plasma for diabetic ulcer: a systematic review,” Growth Factors, 2010; 28(2): 111–116.
15. Akingboye A.A., Giddins S., Gamston P., Tucker A., Navsaria H., Kyriakides C., “ Application of autologous derived-platelet-rich plasma gel in the treatment of chronic Wound ulcer: diabetic foot ulcer”. J Extra Corpor Technol, 2010; 42: 20–29.
16. Crovetti G, Martinelli G, Issi M, et al. “Platelet gel for healing cutaneous chronic wounds”. Transus Apher Sci 2004; 30: 145-1.
17. Saad Setta H, Elshahat A, Elsherbiny K, et al., “Platelet-rich plasma versus platelet-poor plasma in the management of chronic diabetic foot ulcers: a comparative study”. Int Wound J., 2011; 8(3):307-12.
18. Marcus Gurgen, Norway. Maria Hok, Hungary, “Treatment of chronic wounds with platelet rich plasma gel”, EWMA journal, 2008; 8 (2): 5-10.
19. J. P. McAleer, S. Sharma, E. M. Kaplan, and G. Persich, “Use of autologous platelet concentrate in a nonhealing lower extremity wound,” Advances in Skin & Wound Care, 2006; 19(7): 354–363.
20. Steenvorde P, van Doorn LP, Naves C., et al., “Use of autologous platelet-rich fibrin on hard-to-heal wounds”. J Wound Care, 2008; 17: 60-3.