Application of Platelet-Rich Plasma in Plastic Surgery: Clinical andIn VitroEvaluation

Abstract

The clinical use of platelet-rich plasma (PRP) for a wide variety of application has been reportedly employed most prevalently in problematic wounds, maxillofacial and hemi-facial atrophy, Romberg Syndrome, and diabetic foot ulcers. To our knowledge, PRP has never been described in the enhancement of fat grafting during tissue-engineering application in vivo. The authors describe the preparation of PRP and its use in a series of 43 patients who underwent plastic, reconstructive, and maxillofacial surgery for chronic lower extremity ulcers (n = 18) and multiple facial applications (n = 25). PRP mixed with fat grafting was used in 76% patients affected by multiple facial diseases and in 88.9% patients affected by lower extremity ulcers. PRP injection alone was used in the remaining patients. The authors observed that after a 7.1-week and 9.7-week (average) course of twice-daily wound treatment with PRP suspended on a collagen base, 61.1% and 88.9% of chronic lower extremity ulcers underwent to 100% reepithelization compared with 40% and 60% of controls (n = 10) treated with hyaluronic acid and collagen medication. In patients treated with reconstructing three-dimensional projection of face by fat grafting and PRP, we observed a 70% maintenance of contour restoring and three-dimensional volume after 1 year compared to only 31% of controls (n = 10) treated with fat grafting alone. In vitro, PRP induced a significant increase in the number of adipose-tissue-derived stem cells compared to control cultures. These results documented that PRP accelerates chronic skin ulcer reepithelization and improves maintenance and function of fat graft in patients who underwent plastic reconstructive surgery, possibly by stimulating adipose-tissue-derived stem cell proliferation.

A recently developed bifacial platelet-rich fibrin matrix

“…It is also used in orthopaedic and oral maxillofacial surgery where it accelerates autogenous bone graft healing (Fennis et al, 2004;Marx et al, 1998;Simon et al, 2009), and in cosmetic surgery (Man et al, 2001). PRP has also been used in combination with mesenchymal stem cells (MSC) to promote bone regeneration (Hibi et al, 2006;Ito et al, 2006;Kitoh et al, 2004;Kitoh et al, 2007;Lucarelli et al, 2003;Pieri et al, 2008) or mixed with fat cells for breast reconstruction, to correct painful, adherent scars, and to solve progressive hemifacial atrophy (Azzena et al, 2007;Cervelli et al, 2009a;Cervelli et al, 2009b;Cervelli et al, 2009c;Cervelli et al, 2009d;Fulton, 2003).…”

Initial Experience of Face Augmentation Using Fat Graft-Platlet Rich Plasma Mix

“…Eppley et al reported that platelet-rich plasma growth factors stimulate endothelial cells near their application, favoring proliferation and formation of new capillaries [30]. Also, PRP enhances fat graft survival via proliferation of adipose stromal cells (ASCs) or stimulation of ASCs to differentiate into adipocytes [31]. In addition, Kakudo et al showed that activated platelet-rich plasma contains large amounts of PDGF-AB and TGF-β1 that promote the proliferation of human adipose-derived stem cells and human dermal fibroblast in vitro [32].…”

“…PRP is thus used more and more often in the plastic, reconstructive and aesthetic surgery fields [17]- [19].…”

Efficacy of Platelet-Rich Plasma on Fat Grafts in the Repair of Tympanic Membrane Perforations: An Experimental Study

“…These growth factors include platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), and vascular endothelial growth factor (VEGF). Because of this, PRP is frequently used today in craniofacial, orthopedic, and neurological surgery [8][9][10][11] . PRP increases the success of grafting when fat grafts are applied in various regions of the body [11][12][13][14] .…”

“…Because of this, PRP is frequently used today in craniofacial, orthopedic, and neurological surgery [8][9][10][11] . PRP increases the success of grafting when fat grafts are applied in various regions of the body [11][12][13][14] . Moreover, Erkilet et al [15] showed positive effects of PRP when used on its own on the tympanic membrane.…”