SLR - February 2022 - Britain R. Wetzel
Reference: Rani R., Priyanka K. Safety and Efficacy of Platelet Rich Plasma in the Management of Diabetic Foot Ulcer. International Surgery Journal. 2022 Jan;9(1):35-39.Level of Evidence: Level II – Prospective comparative study
Scientific Literature Review
Reviewed By: Britain R. Wetzel, DPM
Residency Program: East Liverpool City Hospital – East Liverpool, OH
Podiatric Relevance: Platelet-rich plasma has been widely debated in its efficacy in many areas across medicine. It has often been described as an adjuvant for patients with a history of trauma, arthritis, and inflammation – but its potential to assist in tissue regeneration in wound care is a new area of interest within the podiatry community. Some critics of PRP state that there is no standardization in the concentration of platelets among individuals, suggesting that some individuals may get varying benefit from their PRP based on their own biology. Another barrier to regular PRP use is the cost to patients, as the process to obtain, prepare, and administer the injection may not be covered by insurances. However, the potential of life and limb saving wound care efforts justify further investigating of the role that platelet-rich plasma may have in healing chronic wounds.
Methods: Fifty patients with diabetic foot ulcers were placed into two groups: the control conventional dressing (n=25) or PRP experimental dressing (n=25) group. Wound sizes among the individuals with both type 1 and type 2 diabetes ranged from 4-7 centimeters. A conventional dressing consisted of a normal saline wet-to-dry dressing, while the PRP dressing consisted of 2mL of PRP injected approximately ¾ from the wound margin, and then covered with a sterile dressing. In both groups, any local infection was controlled, and adequate debridement was performed prior to study. Dressings in both groups were changed every four days and wound measurements were taken to quantify wound contraction and healing. Data was analyzed to represent frequency, percentage, mean and standard deviation. Continuable variables were analyzed using the Pearson Chi square test.
Results: Fifty patients with diabetic foot ulcers were included in this prospective comparative study. Patients were evenly split into two groups and assigned a convention dressing or a PRP dressing for wound care. All patients participating had radiographs taken prior to study to ensure no stress fractures or osteomyelitis were present. Duration for healing was statistically shorter in the PRP group with a mean value of about 4-5 weeks with greater wound contraction in comparison to the conventional dressing changes with a mean value of about 6-7 weeks. Based on these findings, PRP dressings were found to be more effective than standard dressing changes in this population and may be recommended to be used as an adjuvant therapy in the healing of diabetic foot wounds.
Conclusions: Diabetic foot ulcerations are a major cause of morbidity and mortality despite advancing wound care efforts. This study sought to prove that platelet-rich plasma could be used as a safe and effective therapy to aid in tissue regeneration in wounds that have stalled in the inflammatory phase of healing. Within this population, PRP was shown to improve wound contraction and demonstrated faster healing times. Therefore, these authors suggest that PRP is an effective and safe modality to aid in wound healing.