SLR - October 2010 - Emily M. Wasko
Reference: Heong-Ho, J., Seung-Kyu, H., & Woo-Kyung, K. (2010, March). Treatment of diabetic foot ulcers using a blood bank platelet concentrate. Plastic and Reconstructive Surgery, 125, 944-952.
Scientific Literature Reviews
Reviewed by: Emily M. Wasko, DPM
Residency Program: OCPM/University Hospitals Health System Richmond Heights Medical Center
Podiatric Relevance:
As the diabetic population grows, more patients will develop diabetic foot ulcers. These ulcers are particularly difficult to treat and manage due to the wound healing complications of diabetes. This article discusses a relatively simple treatment plan using platelet concentrate from a blood bank.
Methods:
Fifty-two patients with diabetic foot ulcers were included in the study. ABO- and Rh- compatible blood bank concentrate was ordered for the patients. The wounds underwent debridement to remove non-viable tissue. The platelet concentrate was suspended in fibrinogen and applied to the debrided wound. It was then sealed with thrombin and covered with polyurethane film and foam dressing. A second application was performed using the same technique 3-4 days later. The dressings were changed at 3-4 day intervals until complete wound closure occurred. Forty-eight patients were included in a control group and received topical fibrinogen and thrombin only.
Results:
The patients were evaluated at 12 weeks after the application. 41 patients (79%) of the blood platelet concentrate-treated group were completely healed between 3 and 12 weeks, and 22 patients (46%) of the control group patients healed between 6 and 12 weeks. There were no adverse effects reported in the blood bank concentrate treated group. The degrees of wound shrinkage were 96.3 (+/-) 7.8 and 81.6 (+/-) 19.7 percent for the treated and control groups, respectively. Patient satisfaction score was also positive in the treatment group, 7.6 (+/-) 1.6 versus the control group score 5.3 (+/-) 1.4.
Conclusions:
Treatment of diabetic foot ulcers using a blood bank platelet concentrate showed superior results when compared to the control group. Platelets can compensate for the impaired activities of cells crucial for wound healing by improving cell proliferation, angiogenesis, extracellular matrices, and modifying inflammatory processes. In the past, many studies have demonstrated the effectiveness of autologous platelets in chronic wounds. The advanatage of using homologous platelets from a blood bank include elimiating the need for repeated blood sampling in patients who are already anemic or hemodynamically unstable. Concentrated platelets can also be obtained without the need for a platelet separation system. The need to find a suitable donor is also eliminated, however, transmission of viral illnesses cannot be excluded. The use of a blood bank concentrate is also lower in cost than some other bioengineered products. In order for a standard treatment method to be determined, further investigation is required to determine the number of transplanted platelets and the amount of thrombin concentrate required to effectively promote growth factor secretion. Additionally, it is yet to be determined if multiple small doses or one large dose of the concentrate would be most effective. Overall, this is a simple and effective method in the treatment of diabetic foot ulcers.