Role of Platelet Rich Plasma in Enhancing Graft Take in Chronic Venous Ulcers

Fourteen patients had bilateral lower limb ulcers, and 6 of them had single large ulcers as follows; Fourteen patients with chronic venous ulcers (12 of which had bilateral ulcers, 2 had single large ulcers) Four patients, each with a single chronic post-traumatic ulcer Two patients with bilateral chronic lymphatic ulcers.

After detailed history, physical examination and investigations (such as duplex),

• Each patient with bilateral ulcers included in the study (14 patients) received treatment A on one ulcer and treatment B on the other ulcer.
• In case of patients with single large ulcers (6 patients), treatment A was done on one half of the ulcer and treatment B on the other half of the ulcer (done in ulcers with an area greater than 10 x 10 cms).
• Treatment A included pre-operative intra-lesional PRP injections in 1-week intervals for 3 times, followed by intra-operative intra-lesional injection of PRP prior to meshed graft placement. PRP was injected into the ulcer bed and ulcer edges using a sterile syringe.

Treatment B included only placement of meshed graft, with no PRP treatment.

• Pre-operative preparation: Ulcers were prepared by proper dressings and followed up until acquiring a clean bed. Debridement was done as needed to obtain clean base ready for graft placement.
• PRP preparation:

• 10 ml of blood was drawn from each patient intra operatively (autologous PRP).
• Blood was collected in sterile tubes, Anticoagulant Citrate Dextrose (ACD) was used for anticoagulation, which is the same substance used to preserve viable platelets in blood banks for platelet transfer.
• Tubes were centrifuged in Beckman Allerga X-12 centrifuge for 20 mins, 3000 rpm.
• Each 10 ml of blood yielded an average of 3-4 ml of PRP. Calcium gluconate was added in a ratio of 1:10 to PRP. Post-operative assessment was carried out by follow up clinical examination, photography and weekly biopsy samples.

Inclusion criteria

• Patients with chronic ulcers for at least 6 months.
• Age ≧ 12 years.

Exclusion criteria

• Patients younger than 12 years of age.
• Patients with diabetes or other diseases affecting tissue healing.
• Patients with current ongoing pathologies in arterial or venous systems.
• Patients with malignant ulcers.
• Patients on corticosteroids or other drugs affecting tissue healing.
• Patients with unrealistic expectations.