Platelet-rich Plasma Therapy for Wound Healing: Benefits and Limitations
The use of regenerative therapies in wound healing is becoming popular because they require low-invasive procedures. Also, medical experts have in recent years discovered that the body has self-healing capabilities. Platelet-rich plasma (PRP) therapy is a form of regenerative medicine that makes use of such capabilities for effective wound healing. But how exactly is this type of therapy vital to wound healing?
Chronic Wounds and PRP Therapy
A chronic wound is one that has failed to reach anatomic and functional integrity through an orderly and timely sequence of repair. These wounds are usually non-healing, characterized by a prolonged inflammatory phase and in some cases, they tend to recur. Examples of chronic wounds include diabetic foot ulcers, venous leg ulcers, and pressure ulcers.
What is PRP?
PRP is a concentration of one type of cell, known as platelets, and the liquid part of the blood known as plasma. Platelets are critical for blood clotting, and together with liquid plasma, these cells prove to be essential for cell recruitment, multiplication, and specialization – all of which are essential for wound healing.
PRP is produced from one’s blood and is easy to extract with minimal effort in a two-step process. First, whole blood from the patient is put into a centrifuge to separate the plasma from the red blood cells and other blood components. The blood is further centrifuged to separate platelet-poor plasma from platelet-rich plasma and then activated with the addition of thrombin or calcium to form a gelatinous platelet gel. The result is a platelet-rich concentration that is 5 to 10 times greater than the normal.
PRP and Its Clinical Application in Wound Healing
Platelet-rich plasma therapy for wound healing is a potential alternative to wound healing. It contains components such as fibrin – responsible for blood clotting – and high concentrations of growth factors such as PDGF-AB, PDGF-BB, and TGF-β that help in healing. A study indicated that there was complete wound healing in 79% of patients who were treated using a blood-bank platelet concentrate.
The first clinical use of autologous platelet-rich plasma was in the treatment of chronic leg ulcers whereby collagen embedded in platelet proteins was used to cover the wound. As a result, vascularized connective tissue started to form, leading to wound healing. Since then, PRP has been tried and used for application in gel, solution, or by injections in different wounds.
PRP injections use a concentration of a patient’s platelets to initiate the healing process of injured ligaments, tendons, and joints. The activated platelets are injected into wound edges in the wound bed. The doctor may use ultrasound imaging to guide the injection. PRP injections should take place within the first 10 minutes after PRP activation with the procoagulant substance. This way, the injections use one’s own healing system for wound therapy.
When PRP therapy starts, many specialists hope it will initialize the inflammatory response of healing. As such, it’s advised to avoid using any anti-inflammatory medicine during the treatment period.
Benefits of PRP Therapy for Wound Healing
No significant PRP treatment-specific adverse effects have been reported, most probably because it consists of autologous products. Platelet-rich plasma is made from your blood cells, there’s little to zero chance of rejecting the cells.
PRP poses no concern about toxicity, cross-reactions, or immunoreactions. For these reasons, PRP may be utilized in many surgical fields, including the management of chronic wounds. PRPs injections reduce the need for anti-inflammatory drugs or stronger medicine, like opioids, and carry only minimal risks such as infection, tissue damage, or pain at the injection site.
Platelet-rich plasma is effective in the treatment of both acute and chronic wounds. Increased rates of cell proliferation and cell migration have been associated with the upregulation of different cell cycle regulatory proteins.
Using a PRP injection for a ruptured Achilles tendon and other soft-tissue injuries is becoming more common. This is because it provides the wound with adhesive proteins, such as fibrinogen, which are essential for wound care.
Limitations of PRP for Wound Healing
One huge limitation of PRP therapy is inaccessibility. Finding a healthcare facility offering PRP treatment services can be a challenge. Also, very few insurers cover PRP therapy for wound healing.
Growth factors should not be used in malignant wounds. It’s advisable to do a skin biopsy before commencing PRP therapy if malignancy cannot be completely excluded.
PRP is considered by some agencies as a performance-enhancing drug because it contains endogenous growth factors. For this reason, the World Anti-Doping Agency has banned the use of PRP injections within the muscles. There is however no data to back these performance-enhancing claims.
Overall, there is limited data on PRP therapy for wound healing. More research is needed to ascertain the effectiveness of PRP treatment and the best protocols for PRP preparation before treatment.
Platelet-rich plasma represents a viable alternative treatment for chronic wounds that do not respond to conventional treatment. Stronger scientific evidence and the design of clinical protocols are however required to support its potential benefits in wound healing.