Platelet-rich plasma for the treatment of chronic wounds: evidence to date

Abstract

Platelet-rich plasma (PRP) is a widely used throughout diverse fields of medicine for improving tissue regeneration. In dermatology, its main applications in the last few years have mainly been in antiaging treatment and wound healing. PRP contains platelets at higher concentrations than whole blood, and consequently represents a growth-factor pool. Chronic wounds are characterized by a prolonged inflammatory phase, involving a continuous destruction of matrix proteins and growth factors. Growth factors promote cell migration, proliferation, and differentiation, which are essential for wound healing. In this review, we explain the basic principles of PRP in wound healing and aim to offer an updated critical assessment of the available clinical evidence that supports the utility of PRP for the therapeutic challenge that chronic ulcers represent in our daily clinical practice.

Autologous platelet‐rich plasma injection enhances healing of chronic venous leg ulcer: A prospective randomised study

“…Coinciding with previous studies that considered PRP treatment as a safe systemic and local option, 8,10,16,26,27 the complications, in our study, were limited to four occasions of periulcer mild cellulitis and two superficial ulcerations related to faulty application of the bandages.…”

“…Evidence to support the use of PRP to enhance the chronic VLUs healing is deficient. Recent systematic reviews and meta‐analyses and a Cochrane review made a recommendation supporting its use only in diabetic foot wounds but in other wounds, including the VLU, the conclusions were conflicting 8,12,13 . The included studies, in these reviews, enrolled different types of ulcers, with only five studies investigating the use of PRP in a pure sample of venous ulcers 10,11,15‐17 .…”

“…It is believed that the resistance to healing, in this kind of wounds, is related to an imbalance of some factors that lead to excessive prolongation of the second phase of normal wound healing “inflammatory phase.” This entails an increase in cytokines, proteolytic activity, and metalloprotease activity together with reduced fibrin and growth factors content and activity. It is crucial to shut down the prolonged phase and to switch on further phases of wound healing; proliferation, and regeneration 8 …”

Human platelet-rich plasma as a biological stimulant for proliferation and differentiation of mesenchymal stem cells

“…These findings provide evidence that when applied to MSC culture, PRP can stimulate major cell functions such as proliferation, migration, and differentiation, which are important for tissue regeneration. This could partly explain the underlying mechanism of the regenerative capacity of PRP in the wound and musculoskeletal tissues (24,25).…”

“…Platelets are nucleated fragments of megakaryocytes that originate from bone marrow and migrate into the bloodstream, circulating for 7-10 days. As cellular elements, platelets contain a wide protein content in the form of secretory granules (25). Platelet-rich plasma (PRP) is a human platelet concentrated in small volumes of plasma; it is known to be rich in major proteins of growth factors that are actively secreted for wound healing initiation.…”