Autologous platelet-rich plasma (PRP) may enhance wound healing through the formation of a platelet plug that provides both hemostasis and the secretion of biologically active proteins, including growth factors such as platelet-derived growth factor, transforming growth factor (TGF)-β, TGF-β2, and epidermal growth factor. The release of these growth factors into the wound may create an environment more conducive to tissue repair and could accelerate postoperative wound healing. To our knowledge, there are no reports of combining the use of PRP with curative diabetic foot surgery. This article provides a summary of the literature regarding PRP and wound healing and presents a case of a 49-year-old man with diabetes and a three-month history of a deep, nonhealing plantar hallux wound in which PRP was combined with a first metatarsophalangeal joint arthroplasty. Through the use of the PRP and bioengineered tissue to supplement curative diabetic foot surgery, the patient healed uneventfully at seven weeks.
NwomehBCYagerDRCohenIK. Physiology of the chronic wound. Clin Plast Surg.1998;25 (3): 341–56.
2.
MastBASchultzGS. Interactions of cytokines, growth factors, and proteases in acute and chronic wounds. Wound Repair Regen.1996;4 (4): 411–20.
3.
ChenCSchultzGSBlochMEdwardsPDTebesSMastBA. Molecular and mechanistic validation of delayed healing rat wounds as a model for human chronic wounds. Wound Repair Regen.1999;7 (6): 486–94.
4.
SlavkinHCBartoldPM. Challenges and potential in tissue engineering. Periodontol 2000.2006;41: 9–15.
5.
DoucetteMMFyllingCKnightonDR. Amputation prevention in a high-risk population through a comprehensive wound-healing protocol. Arch Phys Med Rehabil.1989;70 (10): 780–5.
6.
KnightonDRFyllingCPDoucetteMM. Wound healing and amputation in a high-risk diabetic population. Wounds.1989;2: 107–14.
7.
KnightonDRFyllingCPFiegelVDCerraF. Amputation prevention in an independently reviewed at-risk diabetic population using a comprehensive wound care protocol. Am J Surg.1990;160 (5): 466–71.
8.
GloverJLWeingartenMSBuchbinderDSPoucherRLDeitrickGA3rdFyllingCP. A 4-year outcome-based retrospective study of wound healing and limb salvage in patients with chronic wounds. Adv Wound Care.1997;10 (1): 33–8.
9.
FyllingCPMcKeownPC. Cost and healing efficacy of treating diabetic foot ulcers in a comprehensive wound management program with growth factor technology. Diabetes.1990;39: 18S.
10.
BentkoverJDChampionAH. Economic evaluation of alternative methods of treatment for diabetic foot ulcer patients: Cost-effectiveness of platelet releasate and wound care clinics. Wounds.1993;5: 207–15.
11.
ArmstrongDGLaveryLABushmanTR. Peak foot pressures influence healing time of diabetic ulcers treated with total contact casts. J Rehabil Res Dev.1998;35 (1): 1–5.
12.
LaveryLAArmstrongDGVelaSAQuebedeauxTLFleischliJG. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med.1998;158 (2): 157–62.
13.
ArmstrongDGLaveryLAVazquezJRShortBKimbrielHRNixonBPBoultonAJ. Clinical efficacy of the first metatarsophalangeal joint arthroplasty as a curative procedure for hallux interphalangeal joint wounds in patients with diabetes. Diabetes Care.2003;26 (12): 3284–7.
14.
MarxRE. Platelet-rich plasma (PRP): What is PRP and what is not PRP?Implant Dent.2001;10 (4): 225–8.
15.
AnituaEAndiaIArdanzaBNurdenPNurdenAT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost.2004;91 (1): 4–15.
LinPHHirkoMKvon FraunhoferJAGreislerHP. Wound healing and inflammatory response to biomaterials. In: ChuCCvon FraunhoferJAGreislerHP, eds. Wound closure biomaterials and devices. Boca Raton: CRC Press; 1997, 7–24.
18.
SlaterMPatavaJKinghamKMasonRS. Involvement of platelets in stimulating osteogenic activity. J Orthop Res.1995;13 (5): 655–63.
19.
KevySVJacobsonMS. Preparation of growth factor enriched autologous platelet gel. Presented at the 27th Annual Meeting of the Society for Biomaterials, St. Paul, MN, April 26, 2001.
20.
SpencerEMTokunagaAHuntTK. Insulin-like growth factor binding protein-3 is present in the alpha-granules of platelets. Endocrinology.1993;132 (3): 996–1001.
GibbleJWNessPM. Fibrin glue: The perfect operative sealant?Transfusion.1990;30 (8): 741–7.
23.
AnituaEAndiaIArdanzaBNurdenPNurdenAT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost.2004;91 (1): 4–15.
24.
OginoYAyukawaYTsukiyamaYKoyanoK. The effect of platelet-rich plasma on the cellular response of rat bone marrow cells in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2005;100 (3): 302–7.
25.
MarxRECarlsonEREichstaedtRMSchimmeleSRStraussJEGeorgeffKR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.1998;85 (6): 638–46.
26.
DoucetteMMFyllingCKnightonDR. Amputation prevention in a high-risk population through a comprehensive wound-healing protocol. Arch Phys Med Rehabil.1989;70 (10): 780–5.
27.
EppleyBLWoodellJEHigginsJ. Platelet quantification and growth factor analysis from platelet-rich plasma: Implications for wound healing. Plast Reconstr Surg.2004;114 (6): 1502–8.
28.
RubinRBasergaR. Biology of disease: Insulin-like growth factor receptor, its role in cell proliferation, apoptosis, and tumorigenicity. Lab Invest.1995;73 (3): 311–31.
29.
WiemanTJSmiellJMSuY. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care.1998;21 (5): 822–7.
30.
D'HemecourtPASmiellJMKarimMR. Sodium carboxy-methylcellulose aqueous-based gel versus becaplermin gel in patients with nonhealing, lower extremity diabetic ulcers. Wounds.1998;10 (3): 69–75.
31.
SmiellJMWiemanTJSteedDLPerryBHSampsonARSchwabBH. Efficacy and safety of becaplermin (recombinant human platelet-derived growth factor-BB) in patients with nonhealing, lower extremity diabetic ulcers: A combined analysis of four randomized studies. Wound Repair Regen.1999;7 (5): 335–46.
32.
KnightonDRCiresiKFFiegelVDAustinLLButlerEL. Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF). Ann Surg.1986;204 (3): 322–30.
33.
DeuelTFKawaharaRSMustoeTAPierceAF. Growth factors and wound healing: Platelet-derived growth factor as a model cytokine. Annu Rev Med.1991;42: 567–84.
LobmannRSchultzGLehnertH. Proteases and the diabetic foot syndrome: Mechanisms and therapeutic implications. Diabetes Care.2005;28 (2): 461–71.
36.
HosgoodG. Wound healing. The role of platelet-derived growth factor and transforming growth factor beta. Vet Surg.1993;22 (6): 490–5.
37.
PierceGFMustoeTAAltrockBWDeuelTFThomasonA. Role of platelet-derived growth factor in wound healing. J Cell Biochem.1991;45 (4): 319–26.
38.
PfeilschifterJOechsnerMNaumannAGronwaldRGMinneHWZieglerR. Stimulation of bone matrix apposition in vitro by local growth factors: A comparison between insulin-like growth factor I, platelet-derived growth factor, and transforming growth factor beta. Endocrinology.1990;127 (1): 69–75.
39.
HosgoodG. Wound healing. The role of platelet-derived growth factor and transforming growth factor beta. Vet Surg.1993;22 (6): 490–5.
40.
BennettSPGriffithsGDSchorAMLeeseGPSchorSL. Growth factors in the treatment of diabetic foot ulcers. Br J Surg.2003;90 (2): 133–46.
41.
WuLXiaYPRothSIGruskinEMustoeTA. Transforming growth factor-b1 fails to stimulate wound healing and impairs its signal transduction in an aged ischemic ulcer model: Importance of oxygen and age. Am J Pathol.1999;154: 301–9.
42.
NeufeldGCohenTGengrinovitchSPoltorakZ. Vascular endothelial growth factor (VEGF) and its receptors. FASEB J.1999;13 (1): 9–22.
43.
BrauchleMFunkJOKindPWernerS. Ultraviolet B and H2O2 are potent inducers of vascular endothelial growth factor expression in cultured keratinocytes. J Biol Chem.1996;271 (36): 21793–7.
44.
DiegelmannRFEvansMC. Wound healing: An overview of acute fibrotic and delayed healing. Front Biosci.2004;9: 283–9.
45.
VaismanNGospodarowiczDNeufeldG. Characterization of the receptors for vascular endothelial growth factor. J Biol Chem.1990;265 (32): 19461–6.
46.
PlouëtJMoukadiriH. Characterization of the receptor to vasculotropin on bovine adrenal cortex-derived capillary endothelial cells. J Biol Chem.1990;265 (36): 22071–4.
47.
CorralCJSiddiquiAWuLFarrellCLLyonsDMustoeTA. Vascular endothelial growth factor is more important than basic fibroblastic growth factor during ischemic wound healing. Arch Surg.1999;134 (2): 200–5.
48.
EppleyBLWoodellJEHigginsJ. Platelet quantification and growth factor analysis from platelet-rich plasma: Implications for wound healing. Plast Reconstr Surg.2004;114 (6): 1502–8.
GanioCTenewitzFEWilsonRMoylesBG. The treatment of chronic nonhealing wounds using autologous platelet-derived growth factors. J Foot Ankle Surg.1993;32 (3): 263–8.
51.
MazzuccoLMediciDSerraMPanizzaRRivaraGOrecchiaSLibenerRCattanaELevisABettaPGBorziniP. The use of autologous platelet gel to treat difficult-to-heal wounds: A pilot study. Transfusion.2004;44 (7): 1013–8.
52.
FalangaV. Wound healing and its impairment in the diabetic foot. Lancet.2005;366 (9498): 1736–43.
53.
HendersonJLCuppCLRossEVShickPCKeefeMAWesterDCHannonTMcConnellD. The effects of autologous platelet gel on wound healing. Ear Nose Throat J.2003;82 (8): 598–602.
54.
CrovettiGMartinelliGIssiMBaroneMGuizzardiMCampanatiBMoroniMCarabelliA. Platelet gel for healing cutaneous chronic wounds. Transfus Apher Sci.2004;30 (2): 145–51.
55.
EvertsPADevileeRJMahoneyC BrownEeftinck-SchattenkerkMBoxHAKnapeJTvan ZundertA. Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty. Acta Anaesthesiol Scand.2006;50 (5): 593–9.
56.
HomDBLinzieBMHuangTC. The healing effects of autologous platelet gel on acute human skin wounds. Arch Facial Plast Surg.2007;9 (3): 174–83.
