The Role of PRP in Wound Care

The clinical benefits of PRP in enhancing healing of persistent wounds, especially those resulting from illness rather than trauma, are significant. Pressure and diabetic ulcers are classic examples. Wound healing is a complex and dynamic process. Normally when a wound begins healing the eventual result is complete wound closure. Healing of acute and chronic wounds, though, can be impaired by factors like separate but simultaneous illnesses or infection, combined with a failure of the vascular system to deliver sufficient healing and regrowth agents to the wound site.

Non-healing wounds need outside assistance – beyond normal wound care – to restart the healing process. By delivering agents like cytokines, growth factors, chemokines, and a fibrin scaffold to the wound, platelet rich plasma stimulates wound healing.

Background to Platelet Rich Plasma (PRP)

Wound healing is a dynamic, interactive process involving multiple cells and proteins interacting sequentially in an integrated series of cellular, physiologic, biochemical, and molecular events and this delicate balance can be interrupted by a number of factors including the presence of infection, ischaemia and extensive trauma. According to Sanchez-Gonzales et al (2012), these factors may increase the level of pro-inflammatory cytokines, triggering an increase in the cellular levels of metalloproteinases, and the resultant decrease in the tissue growth factors, which may result in delayed wound healing.

The Introduction of the clinical paper by Martin, Constantinides and Sarkar 2014 [2] aptly demonstrates the need for this technology:

“Non-healing foot wounds are a significant source of morbidity and mortality in diabetic patients Studies have suggested that 2.5% of diabetics will have a foot ulcer at any one time, which equates to approximately 80,000 people. Foot ulceration is the major contributing factor to the 30 times increased risk of amputation in diabetic patients compared to the general population. Encouraging healing of diabetic foot wounds with rapid coverage of subcutaneous tissues decreases this associated morbidity and cost. This healing is severely impaired for multifactorial reasons in diabetic patients.”

Wound healing is a complex process
The human body heals itself naturally through a complex process during which cells undergo a series of biological changes to facilitate haemostasis, combat infection, migrate into the wound space, deposit a matrix, form new blood vessels, and contract to restore intact skin.

A healthy wound needs a moist environment, adequate perfusion (blood flow) for delivery of nutrients and cellular sources of growth factors, cytokines and chemokines to heal itself naturally.

This new system restores the natural balance for chronic wound repair, the proprietary biodynamic formulation is designed to provide:

  • Plasma derived fibrin and fibronectin scaffolding for tissue repair.
  • Platelet release gel containing growth factors, cytokines and chemokines to stimulate wound healing.
  • Improved collagen synthesis and removal of damaging free radicals.
  • Re-establish the balanced environment missing in chronic wounds.

Fibrin Scaffold Platelet containing growth factors application of PRP gel to prepared wound bed

Indications for use:
Chronic Wound Care Treatment, using the CE Marked Arthrex Angel™ Concentrated PRP Blood Processing System and dedicated kits (as above) including the Arthrex ActivAT Autologous Thrombin Kit, is a totally autologous process intended to be used at point-of-care for the safe and rapid preparation of platelet-rich plasma (PRP) gel from a small sample of the patient’s own blood. Under the supervision of a healthcare professional, the PRP produced by the Arthrex Angel™ Blood Processing System is suitable for the treatment of chronic wounds, where devitalised and necrotic tissue has been fully debrided, including diabetic, traumatic and decubitus (pressure sores).

The totally biological status makes it particularly appropriate for wounds which have been previously hampered
 by repeated infection. Evidence from the Pilot Study suggests that the Biodynamic Haematogel Chronic Wound Care Treatment is particularly useful in the treatment of wounds with large areas of tissue exposure including exposed bone and tendon, including those where major limb amputation would otherwise be considered.

Treatment Frequency
The length of treatment using the Biodynamic Haematogel for Chronic Wound Care will vary by the area and depth of wound, with four weeks being typical for a chronic diabetic foot wound measuring up to 7cm3.

The treatment should be used in conjunction and in combination with standard of care procedures for comprehensive wound management such as:

  • Removal of necrotic or infected tissue
  • Off -loading
  • Blood sugar control in diabetes
  • Use of negative pressure suction dressing
  • Compression therapy for venous stasis ulcers
  • Establishment of adequate blood circulation
  • Maintenance of a moist wound environment
  • Management of wound infection
  • Wound cleansing
  • Nutritional support, blood glucose control for subjects with diabetic ulcers
  • Bowel/bladder care for subjects with pressure ulcers at risk for contamination
  • Management of underlying disease

Contraindications
Biodynamic Haematogel for Chronic Wound Care treatment is contraindicated in the following patients or wounds:

Patients on chemotherapeutic agents

Patients with the following abnormal laboratory test levels:

  • Haemoglobin <10.5 g/dL
  • Platelet count <100 x 109/L
  • Known or suspected current malignancy
  • Wounds remaining necrotic or infected tissue