Use of platelet-rich plasma and modified nanofat grafting in infected ulcers: Technical refinements to improve regenerative and antimicrobial potential

Abstract

Background Surgical reconstruction of chronic wounds is often infeasible due to infection, comorbidities, or poor viability of local tissues. The aim of this study was to describe the authors’ technique for improving the regenerative and antimicrobial potential of a combination of modified nanofat and platelet-rich plasma (PRP) in nonhealing infected wounds.Methods Fourteen patients met the inclusion criteria. Fat tissue was harvested from the lower abdomen following infiltration of a solution of 1,000 mL of NaCl solution, 225 mg of ropivacaine, and 1 mg of epinephrine. Aspiration was performed using a 3-mm cannula with 1-mm holes. The obtained solution was decanted and mechanically emulsified, but was not filtered. Non-activated leukocyte-rich PRP (naLR-PRP) was added to the solution before injection. Patients underwent three sessions of injection of 8-mL naLR-PRP performed at 2-week intervals.Results Thirteen of 14 patients completed the follow-up. Complete healing was achieved in seven patients (53.8%). Four patients (30.8%) showed improvement, with a mean ulcer width reduction of 57.5%±13.8%. Clinical improvements in perilesional skin quality were reported in all patients, with reduced erythema, increased thickness, and increased pliability. An overall wound depth reduction of 76.6%±40.8% was found. Pain was fully alleviated in all patients who underwent re-epithelization. A mean pain reduction of 42%±33.3% (as indicated by visual analog scale score) was found in non-re-epithelized patients at a 3-month follow-up.Conclusions The discussed technique facilitated improvement of both the regenerative and the antimicrobial potential of fat grafting. It proved effective in surgically-untreatable infected chronic wounds unresponsive to conventional therapies.

Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea

“…Among patients who were referred to specialties, those with a low SEP had poor accessibility to frequent clinical visits because of cost or location. DFUs account for a large proportion of rising health care costs for persons with diabetes [35,36]. This would The strength of this study is that its target sample group was randomly selected which can represent the total South Korean population.…”

Platelet-Rich Plasma in Plastic Surgery: A Systematic Review

“…Seventeen studies concerning to combination of PRP application and fat grafts were found, and three of those were RCTs [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. Eight articles fell under the category "reconstruction," focusing on chronic ulcers and wounds (three), scars (three), or breast reconstruction (two).…”

“…Twenty-two authors reported the use of CaCl and/or Thrb for platelet activation [11, 13-15, 18, 19, 21, 24, 28, 30, 31, 37, 39, 42-47, 50, 51, 58]. Nonactivated PRP (na-PRP) was applied in 6 cases [34,[52][53][54][55]57], and two authors reported the use of both na-PRP and a-PRP [22,23]. One author applied photo-activated PRP [40].…”

Nanofat: A therapeutic paradigm in regenerative medicine

“…Segreto et al [ 94 ] evaluated the role of a combination of nanofat grafting with autologous PRP in non-healing infected wounds. The application of nanofat with the micro-needling technique improved the delivery of cellular components into fibro-sclerotic tissues and enhanced the regeneration of soft tissue in chronic non-healing wounds.…”