Effectiveness of Platelet-Rich Plasma and Hyaluronic Acid for the Treatment and Care of Pressure Ulcers

2014 ◽  
Vol 17 (2) ◽  
pp. 152-158 ◽  
Author(s):  
Javier Ramos-Torrecillas ◽  
Olga García-Martínez ◽  
Elvira De Luna-Bertos ◽  
Francisco Manuel Ocaña-Peinado ◽  
Concepción Ruiz

Platelet-rich growth factor (PRGF) is a natural source of growth factors (GF), while hyaluronic acid (HA) is a biopolymer present in the extracellular matrix of skin, cartilage, bone, and brain, among other tissues. Both are involved in the pathophysiological mechanisms underlying wound healing. The objective of this study was to evaluate the clinical efficacy (as measured by ulcer area) and safety (as measured by signs of infection) of PRGF and PRGF plus HA in the treatment of pressure ulcers (PUs). Patients ( N = 100) with 124 Stage II–III PUs were randomized to a control group ( n = 25 PUs) for standard care or to case groups for treatment with one ( n = 34 PUs) or two ( n = 25 PUs) doses of PRGF from their own peripheral blood, or two doses of PRGF plus HA ( n = 40 PUs). All ulcers were followed up every 3 days for a 36-day period. At 36 days, a significant reduction in ulcer area ( p ≤ .001) was observed in all treatment groups, with a mean reduction of more than 48.0% versus baseline. The greatest mean reduction (80.4% vs. baseline) was obtained with the PRGF plus HA regimen. Complete wound healing was observed in 32.0% of PUs treated with two doses of PRGF ( p ≤ .002) and in 37.5% of those treated with two doses of PRGF plus HA ( p ≤ .004). There were no signs of infection in any PUs during the 36-day follow-up period. The degree of wound healing was inversely correlated with the consumption of drugs such as statins and with the peripheral blood platelet levels of patients at baseline.

2019 ◽  
Vol 8 (9) ◽  
pp. 1486 ◽  
Author(s):  
Barbara De Angelis ◽  
Margarida Fernandes Lopes Morais D’Autilio ◽  
Fabrizio Orlandi ◽  
Giampiero Pepe ◽  
Simone Garcovich ◽  
...  

Chronic ulcers are characterized by loss of substance without a normal tendency towards spontaneous healing. The Wound Bed Preparation Guideline advises that after diagnosis, the expert should correct the biological state of the ulcer micro-environment based on TIME principles (Tissue, Infection, Moisture balance, Epidermal). There are many ways to treat such ulcers, for example through use of advanced dressings, negative pressure, surgical toilets, dermal substitutes, autologous skin grafting, and free or local flaps. In vitro and in vivo pre-clinical models hold widely acknowledged potential yet complex limitations. Tissue bioengineering could be an ideal approach to foster innovative strategies in wound healing. Our observational study reports on an in vitro and in vivo evaluation of a bio-functionalized scaffold composed of platelet-rich plasma (PRP) and hyaluronic acid (HA) used in 182 patients affected by chronic ulcers (diabetic and vascular), comparing the results with a control group of 182 patients treated with traditional dressings (HA alone). After 30 days the patients who had undergone the combined treatment (PRP + HA), showed 96.8% ± 1.5% re-epithelialization, as compared to 78.4% ± 4.4% in the control group (HA only). Within 80 days, they had 98.4% ± 1.3% re-epithelialization as compared to 87.8% ± 4.1% in the control group (HA only; p < 0.05). No local recurrence was observed during the follow-up period. PRP + HA treatment showed stronger regenerative potential in terms of epidermal proliferation and dermal renewal compared with HA alone.


2018 ◽  
Vol 1 (2) ◽  
pp. 1-17
Author(s):  
Fahcreza ◽  
Elsa Iskandar ◽  
Rachmat Hidayat ◽  
Petty Purwanita ◽  
Anang Tribowo ◽  
...  

Abstract Background: Chemical trauma to the cornea is an emergency condition of the eye that requires early diagnosis and good treatment. Alkaline have ability to saponify fatty acids in cells and cell membranes which can make penetration into the stroma and destroy proteoglycans and collagen in cells. Aloe vera (AV) contains several active substances that are reported to have anti-inflammatory, immunomodulatory, and wound healing effects. AV has been reported to accelerate the healing process of corneal epithelial defects by increasing fibroblast proliferation, collagen production and growth factor production. This study aims to determine the difference between the effect of aloe vera extract with a concentration of 10%, 20%, 40% and BSS on the healing of extensive corneal lesions in white wistar rats alkaline trauma models. Method: This study was an experimental study with a pre and posttest only with control group design in vivo approach to 30 Wistar white rats which were divided into 5 treatment groups for 3 days. Comparative analysis of effectiveness using the ANNOVA test or the Kruskal Wallis test and continued by the post hoc test. Results: Based on the one way ANOVA test there was a statistically significant difference in effectiveness between the five treatment groups on the percentage of corneal wound healing area and TGF-β expression with an assessment of p = 0,000 each. The administration of alloevera (AV) concentration of 20% had a significant difference in percentage of healing of corneal lesions and TGF-β expression compared with other treatment groups with p = 0,000 each. Large differences in the area of corneal lesions in the 40% AV group were -0.45 in the BBS group, 0.146 in the 10% AV group, 0.493 in the 20% AV group. The difference in the AV group 10% was 0.30 in the BBS group, -064 in the AV group 20%, and -0.14 in the AV group 40%. However, TGFβ expression in the normal control group that did not receive treatment was 54.94 (53.21-56-12). TGFβ levels in the BSS group were 10.44, the 10% aloe vera group was 25.43, 47.99 for the 20% aloe vera group and 37.95 for the 40% aloe vera group. Conclusion: There is a difference between the effect of aloe vera extract with concentrations of 10%, 20%, 40% and BSS on the extensive healing of corneal lesions in white wistar rats with alkaline chemical trauma models.


1987 ◽  
Author(s):  
H Ditter ◽  
Fr R Matthias ◽  
R Voss ◽  
P Rottger

Arachidonic acid metabolites seem to play a pivotal role in the pathophysiology of endotoxin (ET) shock. Therefore, attempts to intervene into the balance of eicosanoids may affect the course of ET shock. Several studies had shown a reduction of ET-induced mortality by non-steroidal antiinflammatory drugs in various animal species.We investigated whether an infusion of prostacyclin (PGI2) has an effect on survival rates and on the incidence of renal microclots in a rabbit shock model, which is based on an intravenous infusion of ET over 4 hours. Thirty animals being exposed to 75 μg/kg x h of lipopolysaccharide B, were allocated to three groups (E, El, EA; n=10 each), either receiving ET only (E), or PGI2 (500 ng/kg x min) simultaneously to ET (El), or aspirin (20 mg/kg) before ET (EA).A control group (C; saline infusion) consisted of 8 animals.At the end of the observation period (8 hours), the mortality of the treated animals (El and EA: 4/10 each) was significantly lower than in group E (8/10). However, only in the PGI2-treated group El a significant reduction of ET-induced glomerular fibrin deposition (GFD) was observed. Indices of GFD after semi-quantitative evaluation of renal slices were 10/27 (E), 1/24 (El), 3/21 (EA), and 0/24 (C). PGI2 exerted a platelet protective effect as shown by higher blood platelet counts (El 61.3 % vs. E 33.4 % of initial values), and a better preserved aggregation (El 60.5 % vs.E 31.7 %) and thromboxane formation capacity (El 52.0 ng/ml vs.E 23.4 ng/ml) of platelet rich plasma stimulated by 5 μg/ml collagen (all values at six hours after the start of ET infusion).ET caused a profound granulocytopenia which was not prevented by PGI2. Furthermore, PGI2 did not affect the ET-induced metabolic acidosis.These data confirm a beneficial effect of prostacyclin during a prolonged endotoxemia in rabbits, which may be a consequence of the known vasodilating, platelet inhibiting and cytoprotective properties of the substance.


2020 ◽  
pp. 088532822096389
Author(s):  
Gamze Kara Magden ◽  
Cigdem Vural ◽  
Busra Yaprak Bayrak ◽  
Candan Yilmaz Ozdogan ◽  
Halime Kenar

Despite the fast development of technology in the world, diabetic foot wounds cause deaths and massive economical losses. Diabetes comes first among the reasons of non traumatic foot amputations. To reduce the healing time of these fast progressing wounds, effective wound dressings are in high demand. In our study, sheep small intestinal submucosa (SIS) based biocompatible sponges were prepared after SIS decellularization and their wound healing potential was investigated on full thickness skin defects in a diabetic rat model. The decellularized SIS membranes had no cytotoxic effects on human fibroblasts and supported capillary formation by HUVECs in a fibroblast-HUVEC co-culture. Glutaraldehyde crosslinked sponges of three different compositions were prepared to test in a diabetic rat model: gelatin (GS), gelatin: hyaluronic acid (GS:HA) and gelatin: hyaluronic acid: SIS (GS:HA:SIS). The GS:HA:SIS sponges underwent a 24.8 ± 5.4% weight loss in a 7-day in vitro erosion test. All sponges had a similar Young’s modulus under compression but GS:HA:SIS had the highest (5.00 ± 0.04 kPa). Statistical analyses of histopathological results of a 12-day in vivo experiment revealed no significant difference among the control, GS, GS:HA, and GS:HA:SIS transplanted groups in terms of granulation tissue thickness, collagen deposition, capillary vessel formation, and foreign body reaction (P > 0.05). On the other hand, in the GS:HA:SIS transplanted group 80% of the animals had a complete epidermal regeneration and this was significantly different than the control group (30%, P < 0.05). Preclinical studies revealed that the ECM of sheep small intestinal submucosa can be used as an effective biomaterial in diabetic wound healing.


2020 ◽  
Vol 2020 ◽  
pp. 1-15
Author(s):  
J. Raúl Olmos-Zuñiga ◽  
Matilde Baltazares-Lipp ◽  
Claudia Hernández-Jiménez ◽  
Rogelio Jasso-Victoria ◽  
Miguel Gaxiola-Gaxiola ◽  
...  

Treatment of tracheal stenosis is occasionally performed in combination with wound healing modulators to manipulate new extracellular matrix (ECM) formation and prevent fibrosis. Hyaluronic acid (HA) and collagen-polyvinylpyrrolidone (collagen-PVP) decrease fibrosis in experimental tracheal healing. However, they have not been used clinically as their effect on ECM components, which modify tracheal scarring, has not been described. Objective. To evaluate the effect of the application of HA, collagen-PVP, a mixture of HA and collagen-PVP (HA+collagen-PVP), and mitomycin C on the expression of decorin, matrix metalloproteinase 1 (MMP1), and MMP9, as well as the type of collagen and deposits formed in the scar after resection and end-to-end anastomosis (REEA) of the cervical trachea using an experimental model. Materials and Methods. Thirty dogs underwent REEA of the cervical trachea and were treated with different wound healing modulators: group I (n=6), control; group II (n=6), HA; group III (n=6), collagen-PVP; group IV (n=6), HA+collagen-PVP; and group V (n=6), mitomycin C. The dogs were evaluated clinically and endoscopically for 4 weeks. Subsequently, macroscopic and microscopic changes, expression of ECM proteins, and collagen deposition in tracheal scars were analysed. Results. Groups II, III, and IV showed reduced endoscopic, macroscopic, and microscopic inflammation, improved neovascularization, high decorin expression (p<0.01, analysis of variance (ANOVA)), and moderate expression of MMP1 (p<0.003, ANOVA) and type I and III collagen (p<0.05, Kruskal–Wallis). Groups IV and V developed fewer collagen deposits (p<0.001, ANOVA). Conclusion. Treatment with HA and collagen-PVP improved post-REEA healing by increasing neovascularization, stimulating the expression of decorin, and regulating the expression of MMP1, as well as type I and III collagen and their deposition.


2020 ◽  
Vol 29 (Sup9a) ◽  
pp. S39-S47
Author(s):  
Hideyuki Yanagi ◽  
Hiroto Terashi ◽  
Yoshimitsu Takahashi ◽  
Katsuyuki Okabe ◽  
Katsumi Tanaka ◽  
...  

Objective: To clarify the surgical indications and the appropriate perioperative management of ischial pressure ulcers (PUs). Method: A two-year prospective, nationwide registry study was carried out across 26 medical institutions in Japan. All participating institutions managed ischial PUs according to the standardisation of total management and surgical application for the refractory decubitus (STANDARDS-I) perioperative protocol. Analysis was conducted on a range of clinically or statistically important variables for the achievement of primary or secondary endpoints: complete wound healing and hospital discharge at three months, and complete wound healing at one month after surgery, respectively. Results: A total of 59 patients took part in the study. All patients underwent surgery for ischial PUs during the study period. Patients who had achieved the primary endpoint had a higer preoperative functional independence measurement (FIM score), a higher ‘G’ score in the DESIGN-R scale and were more likely to have healed by primary intention. Patients who had achieved the secondary endpoint were more likely to have spastic paralysis, preoperative physiotherapy and localised infection of the wound, among other variables. Conclusion: This survey suggests that preoperative physiotherapy increases the speed of wound healing, and good granulation of the wound bed preoperatively increases the likelihood of woundless discharge from hospital, whereas the existence of comorbidities negatively influences the likelihood of woundless discharge from hospital. The study also suggests that the existence of spastic paralysis, preoperative infection of the wound, or surgical reduction of the ischial tubercle speeds up the healing of the wound. However, the wound failed to heal significantly more often in patients with increasing white blood cell count after surgery.


2021 ◽  
Vol 56 (3) ◽  
pp. 186
Author(s):  
Thomas Eduardus Sudrajat Wahyu Nugroho ◽  
Sitti Rizaliyana ◽  
David S Perdanakusuma

Background:Closure of the defect with a random skin flap is constrained by the extent of the defect area. Several studies have shown the benefits of administration of PRP (Platelet Rich Plasma) in random skin flap. The purpose of this study is to compare the effect of PRP injection given before flap elevation, after flap elevation and control on the extended random skin flap procedures in rats.Methods: This research is experimental with randomized post test only control group design (n = 27, divided into 3 treatment groups) that compare the effectiveness of PRP injection 24 hours prior to the elevation of the flap, after the elevation of the flap, and control in the extended random skin flap in rats. Random skin flap is made in the ratio 1: 5 on the rat skin. Measurement of viable area were observed on days 1, 7 and 14.Results: There were significantly increased viability of random skin flap on the group with PRP injection 24 hours prior flap elevation compared to other group of treatment. The average of viability on day first 39%±13% ;42%±34%; 62%±14%. On day 7th24%±13%; 36%±26%; 62%±12%.On day 14th16%±15%; 28%±22%; 60%±11%.Conclusion: Injection of PRP on extended random skin flap on rat 24 hours before flap elevationincrease viability of the flap compared to control group and group which receive PRP injection on extended random flap on rat skin after elevation of the flap. Viability increased due to angiogenesis stimulation after PRP injection.


2014 ◽  
Vol 13 (2) ◽  
pp. 86
Author(s):  
Hendrik Setia Budi ◽  
Ira Arundina ◽  
Retno Indrawati ◽  
Leonita Widyana Mahardikasari

The sap of ambonese banana (Musa paradisiaca var sapientum) contain flavonoids, saponins, tannins which have beenwidely used by people in Trunyan Bali as traditional medicine on wound healing, and it has been reported as apotential wound healing after tooth extraction. The aim of this research was to determine the level of safety of usingherbal medicine, ambonese banana stem extract on histopatology liver of mice with LDparameters. This experimentalstudy was performed bythe post test only controlled group design. The sample were 28 mice (Mus musculus) randomlydivided into 4 groups. K group as control group was given aquadest. P1, P2, and P3, as treatment groups were givenambonese banana stem extract with dose 0.42g/20gbw, 2.1g/20gbw, 4.2g/20gbw. The extract was given per-oral withsonde on the first day. On day 3, the mice were terminated, and the livers were microscopically histopathological observed. The observed at 3th50 day, there were no deaths in every groups of mice (K, P1, P2, and P3) on the third day observation. Kruskal Wallis test showed there was not significant difference in histopathological appearance on liverof mice (p=0.771). It wasconcluded that the maximumsafety dose that can still be administered is 0.42g/20gbw followingthe LDparameter. Theacute toxicity test of ambonese banana stem extract did not show necrosis on liver but it showedthe highest simple degeneration than all groups which were given 0.42g/20gbw dose.


2020 ◽  
Vol 8 (A) ◽  
pp. 666-689
Author(s):  
Mary Moheb Ramzy ◽  
Tarik Ahmed Essawy ◽  
Ali Shamaa ◽  
Saher Sayed Ali Mohamed

Background: Delayed healing of diabetic wounds has been well-documented. Currently, the use of platelet-rich plasma (PRP) has attracted great attention in many medical fields including wound healing. Aim: Histological, immunohistochemical and ultrastructural evaluation of the effect of PRP on wound healing in the tongue of normal and Streptozotocin-induced diabetic albino rats. Methodology: A total number of 108 adult male albino rats with average weight 200gm, were used in the study. The animals were classified into two main groups: non-diabetic and diabetic groups. Each group was further divided into three subgroups: non- treated wound, PRP-treatment before wound, and PRP-treatment after wound. Tongue specimens were dissected on postoperative days 1, 3, and 7. The specimens were examined histologically by H&E, immunohistochemically by p63 and vimentin, and ultra-structurally by TEM. Results:  The most accelerated wound healing was revealed in the subgroups treated with PRP before the wound, whether non-diabetic or diabetic, which occurred very early at the 3rd day postoperative in both cases. While complete wound healing was revealed at the 7th day postoperative in both the non-diabetic and diabetic subgroups treated with PRP after the wound, which was like the non-diabetic control subgroup. Whilst, the diabetic non-treated subgroup only showed partial wound healing at the 7th day postoperative. Conclusion: A single injection of PRP could be used as a prophylactic to prevent expected impaired wound healing in diabetic oral mucosal wounds and to enhance wound healing in non-diabetic wounds. PRP could be used as a therapeutic to enhance wound healing in diabetic and non-diabetic oral mucosal wounds. Key Words: platelet rich plasma, wound healing, diabetes, rat, tongue, p63, vimentin, TEM BACKGROUND: Delayed healing of diabetic wounds has been well-documented. At present, the use of platelet-rich plasma (PRP) has attracted great attention in many medical fields including wound healing. AIM: Histological, immunohistochemical, and ultrastructural evaluation of the effect of PRP on wound healing in the tongue of normal and streptozotocin-induced diabetic albino rats. METHODOLOGY: A total number of 108 adult male albino rats with average weight 200 g were used in the study. The animals were classified into two main groups: Non-diabetic and diabetic groups. Each group was further divided into three subgroups: Non-treated wound, PRP-treatment before wound, and PRP-treatment after wound. Tongue specimens were dissected on post-operative days 1, 3, and 7. The specimens were examined histologically by H&E, immunohistochemically by p63 and vimentin, and ultrastructurally by TEM. RESULTS: The most accelerated wound healing was revealed in the subgroups treated with PRP before the wound, whether non-diabetic or diabetic, which occurred very early at the 3rd day post-operative in both cases. While complete wound healing was revealed at the 7th day post-operative in both the non-diabetic and diabetic subgroups treated with PRP after the wound, which was like the non-diabetic control subgroup. While, the diabetic non-treated subgroup only showed partial wound healing at the 7th day post-operative. CONCLUSION: A single injection of PRP could be used as a prophylactic to prevent expected impaired wound healing in diabetic oral mucosal wounds and to enhance wound healing in non-diabetic wounds. PRP could be used as a therapeutic to enhance wound healing in diabetic and non-diabetic oral mucosal wounds.


2021 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Elisabeth Natalia Barung ◽  
Rifny Wungow ◽  
Donald Emilio Kalonio

Rimpang Temulawak atau Curcuma xanthorriza Roxb. adalah tanaman yang dikenal luas oleh masyarakat sebagai obat tradisional. Rimpang temulawak mengandung kurkumin dan xanthorrizzol, yang diketahui mampu mempercepat penutupan luka di kulit dan juga memiliki efek antibakteri dan antiinflamasi. Penelitian ini bertujuan untuk untuk mengetahui efektifitas perasan rimpang temulawak terhadap percepatan penutupan luka sayat pada tikus putih. Penelitian ini adalah penelitian eksperimen, dengan subyek 10 ekor tikus putih yang dibagi dalam 2 kelompok perlakuan yaitu kelompok yang diberi perasan temulawak dan kelompok kontrol negatif yang tidak diberi perlakuan. Data dikumpulkan dengan mengukur panjang luka tikus menggunakan alat ukur penggaris dan dihitung persentasi penutupan luka. Data dianalisis menggunakan analisis regresi linear dan nilai slope (b) dinyatakan sebagai kecepatan penutupan luka. Hasil penelitian ini, menunjukan bahwa rimpang temulawak mampu mempercepat penutupan luka sayat sebesar 15,262%/hari dibandingkan kelompok yang tidak diberi perlakuan sebesar 13,54%/hari. Kata Kunci: Perasan Rimpang Temulawak, Luka Sayat, Percepatan Penutupan Luka, Sediaan Sederhana, Obat Tradisional Indonesia Curcuma xanthorrhiza Roxb. is a plant that is widely known by the community as traditional medicine. The rhizome of C. xanthorrhiza contains curcumin and xanthorrhizol, which are known to be able to accelerate wound healing on the skin and also has antibacterial and anti-inflammatory effects. This study was aimed to determine the effectiveness of C. xanthorriza rhizome on the acceleration of incision wound healing on white rats. This study was an experimental study, with 10 white rat subjects divided into two treatment groups, namely the treatment group which was given by C. xanthorriza rhizome and the negative control group that was not treated. Data were collected by measuring rat wound length using a ruler and calculating the percentage of wound healing. By using linear regression analysis and the value of the slope (b) is expressed as the acceleration of wound healing. The results of the study showed that C. xanthorrhiza rhizome was able to accelerate incision wound healing by 15.262% / day compared to the untreated group of 13.54% / day.


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