SLR - May 2017 - Shawn B. Khademi
Reference: Ahmed, M, Reffat SA, Hassan A, Eskander F. Platelet-Rich Plasma for Treatment of Clean Diabetic Foot Ulcers. Ann Vasc Surg. 2017 Jan; 38:206–211.Scientific Literature Review
Reviewed By: Shawn B. Khademi, DPM
Residency Program: St. Elizabeth’s Medical Center, Brighton, MA
Podiatric Relevance: Autologous platelet-rich plasma (PRP) is increasingly used in the surgical community for various adjunct applications in the treatment of soft tissue and osseous pathology, specifically in accelerating bone healing and management of chronic nonhealing wounds. PRP has the advantage of utilizing a patient’s own growth factors essential to natural wound healing, something that is commonly compromised in a chronic diabetic foot ulceration. This study seeks to determine the efficacy of PRP utilized in healing of a diabetic ulceration compared to a commonly used antiseptic ointment dressing.
Methods: This was a prospective comparative study that took place in an Egyptian hospital between 2012 and 2014. Fifty-six patients living with diabetes were recruited and randomly allocated into two groups: one group receiving PRP injections twice weekly and another group receiving daily wound care dressing changes with Povidone Iodine ointment. End of study points were wound closure, occurrence of infection or a maximum of three months' dressing for each wound.
Results: Complete wound healing was achieved after two weeks in seven percent of the control group versus 29 percent of the PRP group. This trend continued through the four-week study point but decreased at the eight-week and 12-week study points within the PRP group (0.5 and 0.4 cm2/week mean rate of growth for the control group vs. 0.6 and 0.2 cm2/week for PRP group, respectively). By the end of 12 weeks, 68 percent of the control patients had healed ulcers in comparison to 86 percent of the study group of patients. There was no significant statistical difference regarding age, gender, associated risk factors, other laboratory parameters or ankle-brachial pressure indices between both groups.
Conclusions: The authors conclude that diabetic foot ulcerations devoid of infection or ischemia have a growth factor deficiency that does not allow them to heal properly. This complements the use of PRP as it provides endogenous growth factors compatible with the host to promote wound healing. The study ultimately found that 86 percent of patients who underwent PRP had complete healing of their ulceration after three months in comparison to just 68 percent of patients utilizing conventional dressing. It highlights the importance of PRP as an important and viable wound care modality that can be used in conjunction with other well-known and practiced principles (i.e., serial debridements, off-loading, etc.) in order to achieve optimal healing potential. Although the authors of this study sought to have definitive reasoning due to the prospective comparative nature of the subject matter, there continues to be a need for additional studies to further validate the use of PRP in healing potential of chronic diabetic foot ulcerations.