Treatment of severe pressure ulcers with protein-enriched filtered platelet-rich plasma (PEFPRP): a possible management

Laura Mazzucco; Valeria Balbo; Enrico Maria Zingarelli; Manuela Desilvestri; Manuela Marchioni; Luca Perrero; Francesca Pollis; Ilaria Varvello

doi:10.3389/fbioe.2023.1279149

Treatment of severe pressure ulcers with protein-enriched filtered platelet-rich plasma (PEF_PRP): a possible management

Front Bioeng Biotechnol. 2024 Jan 15:11:1279149. doi: 10.3389/fbioe.2023.1279149. eCollection 2023.

Authors

Laura Mazzucco¹, Valeria Balbo¹, Enrico Maria Zingarelli², Manuela Desilvestri³, Manuela Marchioni³, Luca Perrero², Francesca Pollis¹, Ilaria Varvello³

Affiliations

¹ Transfusion Medicine and Regeneration Medicine, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
² Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
³ Neuro-Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo-Alessandria, Alessandria, Italy.

Abstract

Background: Biological dressings with non-transfusion blood components are among the treatments available for pressure ulcers (PUs). Biological dressings contain active concentrated pro-regenerative molecules that can modify and switch off local inflammatory pathways. This re-establishes the physiological homing, which results in healing. In our study, we used a biological component obtained by ultrafiltration of plasma-platelet concentrate: protein-enriched filtered platelet-rich plasma (PEF_PRP) with a higher platelet and higher plasma protein concentration. We tested whether treatment with PEF_PRP could improve healing in advanced-stage pressure ulcers with a large surface area. All the patients in this study had a surgical indication but were not able to undergo surgery for various reasons. Materials and methods: Ten patients with severe neurological disability and advanced-stage sacral pressure ulcers were treated with allogenic PEF_PRP. The mean lesion surface area at T0 was 13.4 cm² ( ± 9.8 SD). PEF_PRP was derived from allogenic plasma-platelet apheresis that had been pre-ultrafiltered with a ProSmart™ filter (Medica, Italy) to obtain a concentration after filtration of the plasma protein (12-16 g/dL) and platelet (1-1.2 x 10⁶ microL). Results and Conclusion: All cases showed a reduction in the surface area of the pressure ulcer and in the Pressure Ulcer Scale for Healing (PUSH) score. The mean reduction values at week 6 were as follows: -52% for surface area and -21% for PUSH. Rapid wound healing is fundamental to avoid infections and improve patients' quality of life. This blood component builds new tissue by creating a new extracellular matrix. This, in turn, promotes rapid restoration of the three-dimensional structure of the tissue necessary for healing deeper wounds. PEF_PRP shrinks the PU and improves its morphological features (reducing undermining and boosting granulation tissue). PEF_PRP also promotes tissue restoration, obtaining an optimal scar. It is a safe and feasible treatment, and these preliminary results support the use of PEF_PRP in the treatment of pressure ulcers. PEF_PRP dressings could be integrated in the standard treatment of advanced-stage PU.

Keywords: dressing; neurologic patient; plasma proteins; pressure ulcers; protein-enriched filtered platelet-rich plasma (PEFPRP).

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.