Biological approach for the management of non-healing diabetic foot ulcers

Elena Perez-Zabala; Andima Basterretxea; Ainara Larrazabal; Karmele Perez-Del-Pecho; Eva Rubio-Azpeitia; Isabel Andia

doi:10.1016/j.jtv.2016.03.003

Biological approach for the management of non-healing diabetic foot ulcers

J Tissue Viability. 2016 May;25(2):157-63. doi: 10.1016/j.jtv.2016.03.003. Epub 2016 Mar 23.

Authors

Elena Perez-Zabala¹, Andima Basterretxea², Ainara Larrazabal³, Karmele Perez-Del-Pecho⁴, Eva Rubio-Azpeitia⁵, Isabel Andia⁶

Affiliations

¹ Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Mariaelena.perezzabala@osakidetza.eus.
² Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Andima.basterretxeaozamiz@osakidetza.eus.
³ Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Ainara.larrazabalarbaiza@osakidetza.eus.
⁴ Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Karmele.perezdelpecho@osakidetza.eus.
⁵ BioCruces Health Research Institute, Cruces University Hospital, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Eva.rubioazpeitia@osakidetza.eus.
⁶ BioCruces Health Research Institute, Cruces University Hospital, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: iandia2010@hotmail.com.

PMID: 27038643
DOI: 10.1016/j.jtv.2016.03.003

Abstract

Objective: To show an approach to profit of the main components of platelet rich plasma (PRP), i.e. the signaling proteins, and the fibrin scaffold and discuss the intervention within TIME (Tissue, Inflammation/Infection, Moisture, Edges) framework.

Methods: Two patients with diabetic foot ulcers are treated with both liquid and gelled PRP, and the rationale for the PRP intervention is described herein. Autologous blood is withdrawn and, PRP is separated by single spinning and activated with CaCl2 prior to application. PRP is injected in an activated liquid form, i.e. freshly activated, before coagulation, within the wound edges. In fibrotic tissue PRP is introduced performing a needling procedure. In addition, PRP, clotted ex-vivo, is applied in the wound bed as a primary dressing.

Results: Both patients responded positively to PRP intervention. Case 1 healed after five weekly PRP applications. Case 2 healed after eight weekly PRP applications. Patient satisfaction was high in both cases. The procedure had no complications, is well tolerated and easy to perform in any medical setting.

Conclusion: PRP intervention is safe and if associated with correct tissue debridement and preparation of the host tissue it may help to decrease the burden of diabetic foot ulcers. Carefully designed randomized clinical trials with special attention to the PRP procedure are needed to assess the efficacy of these interventions.

Keywords: Cytokines; Diabetic foot ulcer; Fibrosis; Growth factors; Platelet rich plasma.

Publication types

Case Reports

MeSH terms

Diabetic Foot / therapy*
Humans
Male
Middle Aged
Platelet-Rich Plasma*
Treatment Outcome