Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review

Abstract

AIMTo determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates.METHODSA systematic review was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV investigations of topical PRP application in DFUs were sought in multiple databases including: MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The search terms used were “platelet rich plasma”, “diabetes”, “ulcers”, and “wound”. The Modified Coleman Methodology Score (MCMS) was used to analyze study methodological quality. Study heterogeneity and a mostly non-comparative nature of evidence precluded meta-analysis. Only the outcome measurements used by more than 50% of the studies were included in the data synthesis to increase power of the measurement over that of individual studies. A weighted mean of healing rate per week between PRP group vs controls were compared using two-sample z-tests using P-value of less than 0.05 for significance.RESULTSOne thousand two hundred and seventeen articles were screened. Eleven articles (322 PRP subjects, 126 controls, PRP subject mean age 58.4 ± 7.2 years, control mean age 58.7 ± 5.9 years) were analyzed. Six articles were level II evidence, four were level III, and one article was level IV. The mean MCMS was 61.8 ± 7.3. Healing rate was significantly faster with PRP application compared to controls (0.68 ± 0.56 cm2/wk vs 0.39 ± 0.09 cm2/wk; P < 0.001). Mean heal time to > 90% of the original ulcer area was 7.8 ± 2.7 wk and 8.3 ± 3.7 wk for patients in the PRP group and control groups, respectively (P = 0.115). There were significantly lower adverse effects reported with PRP application compared to controls (7 wound infections, 1 contact dermatitis vs 14 wound infections, 1 maceration; P < 0.001).CONCLUSIONThe topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls.

A comparative study on the efficacy of platelet rich plasma vs conventional wound dressing in diabetic foot ulcers

“…In the present study, out of the 50 study participants, 70% of the patients were more than 50 years of age. This is expected as usually older age is associated with a longer duration of diabetes which directly increases risk of 15,[17][18][19] The study population in the present study was mostly male. This finding was in line with findings in former studies.…”

“…Various studies have clinically proven that administration of PRP dressings achieve a faster healing rate and much shorter healing times, better wound closure, lesser adverse effects such as maceration and contact dermatitis, minimal chances of infections, and lesser reopening of wounds. 10,11,13,15,19,20,24,25…”

“…Studies have found that, if used along with correct tissue debridement and host tissue platelet-rich plasma therapy for diabetic foot ulcers is safe with superior healing outcomes and lower complication rates and may significantly help to decrease the burden of diabetic foot ulcers. [9][10][11][12][13][14][15][16][17] The present study is an attempt to add to the existing body of literature on diabetic foot ulcer management using PRP, which is relatively limited in India. The aim of the study is to compare the efficacy of PRP dressing with conventional wound dressing with respect to wound reduction in patients with chronic DFU.…”

The use of platelet-rich plasma in medicine with particular reference to dentistry and aesthetic medicine

“…6 Local and cyclic administration of platelet-rich plasma (every two weeks) results in statistically faster epithelialisation and closure of the wound, improved sensation and nerve regeneration, and fewer complications compared to standard surgical treatment. 1,24,27,28 Moreover, the combination of standard surgical treatment and platelet-rich plasma therapy will reduce capillary bleeding (elimination of drains), diminish pain and swelling, shorten treatment time. 24 Highly concentrated PRP was also used in treatment of androgen alopecia (AGA), commonly affecting men and women.…”

“…6 Miejscowe i cykliczne podawanie osocza bogatopłytkowego (co ok. 2 tygodnie) powoduje statystycznie szybszą epitelializację i zamknięcie rany, poprawę uszkodzonego czucia i regenerację nerwów oraz mniejsze powikłania w porównaniu z standardowym leczeniem chirurgicznym. 1,24,27,28 Ponadto skojarzenie klasycznego leczenia chirurgicznego i terapii osoczem bogatopłytkowym redukuje krwawienie włośniczkowe (brak konieczności stosowania drenów), zmniejszenie bólu i obrzęku, krótszy czas rekonwalescencji. 24 Wysokoskoncentrowane PRP zastosowano Anitua et al showed positive effects of platelet concentrates on tanocytes, proving their effect on the proliferation of these cells and the release of activators of angiogenesis.…”