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Artificial Dermis and Autologous Platelet-Rich Plasma for Treatment of Refractory Wounds: A Clinical Study
Lv Y, Yang Z, Chen Z, Xie J, Li H, Lou Y, Cao D
The international journal of lower extremity wounds. 2021;:15347346211050710
Abstract
Refractory wounds present a complex and serious clinical dilemma in plastic and reconstructive surgery. However, there are currently no standard guidelines for the treatment of refractory wounds. Artificial dermis (AD) has achieved some satisfactory results, but also has some limitations. Autologous platelet-rich plasma (PRP), as a cell-therapy material, was a valuable and safe treatment dressing for chronic non-healing wounds. This study aimed to evaluate the efficacies of artificial dermis (AD) with and without autologous platelet-rich plasma (PRP) in patients with refractory wounds. Sixteen patients with refractory wounds were randomly allocated to autologous PRP therapy combined with artificial dermis (PRP + AD [N = 8]) or an artificial dermis program only (AD [N = 8]). We compared the efficacies of the two methods in terms of times to wound healing, infection control, and AD vascularization, as well as hospitalization days and eventual clinical outcomes.13 patients achieved complete healing, including seven (87.5%) in the PRP + AD group and six (75.0%) in the AD group (P > .05). The times to wound healing, infection control, and AD vascularization, and hospitalization time after transfer were significantly shorter in the PRP + AD group compared with the AD group (P < .05). In conclusion, the combination of AD and PRP promoted refractory wound healing and shortened waiting times compared with simple dermal grafts.
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2.
Comparing novel versus conventional technique of platelet-rich plasma therapy in periorbital hyperpigmentation: A randomized prospective split-face study
Budania A, Mandal S, Pathania YS, Lahoria U, Khan MA, Puri I, Mishra R
Journal of cosmetic dermatology. 2021;20(10):3245-3252
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been found to be effective in treating periorbital hyperpigmentation (POH). PRP prepared by double-spin (DS) method and activated by calcium has been used conventionally. PRP can be prepared by single spin (SS) and activated at low temperature (novel method), but the evidence is limited. OBJECTIVE To compare the novel and conventional PRP in the treatment of periorbital hyperpigmentation. METHODS We selected 21 patients of POH and randomly divided the face into two halves. One-half of the face (group A) was treated with novel PRP (SS and low-temperature activation). The other half (group B) was treated with conventional PRP (DS and calcium activation). A total of 3 PRP injections were given at 4 weekly intervals. Patients were observed and assessed on 12(th) week by photography, dermoscopy, visual analog scale (VAS) score, and Dermatology life quality index (DLQI). Platelet counts and growth factors were assessed in PRP. RESULTS Mean platelet count in novel and conventional PRP was 7.41 ± 1.76 lacs and 8.17 ± 2.23 lacs (p = 0.348). Mean photographic and dermoscopic assessment at the end of the study in group A and group B was 52.33 ± 6.468 and 53.14 ± 6.99 (p = 0.151). Change in VAS in groups A and B was 3.85 ± 1.27 and 3.90 ± 1.04 (p = 0.895). Levels of various growth factors assessed by ELISA did not differ significantly. There was significant decline in DLQI. CONCLUSION The novel method is not inferior to conventional method of PRP in the treatment of periorbital hyperpigmentation.
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3.
Platelet-rich plasma versus carboxytherapy for the treatment of periocular hyperpigmentation; which approach is superior?
Asilian A, Amiri A, Mokhtari F, Faghihi G, Iraji F, Mozafarpoor S
Dermatologic therapy. 2021;:e14980
Abstract
Periorbital hyperpigmentation (POH) is a common aesthetic condition causing people referring to dermatology clinics. Although the therapeutic approach is steeply dependent to the etiology of POH, the gold standard approach of treatment is still a question. The current study is designed to compare the use of carboxytherapy vs platelet-rich plasma (PRP) for the treatment of POH. In the current clinical trial, number of 21 patients with POH underwent carboxytherapy in one side of the face and PRP therapy on the other side. SPSS software version 22 was used with independent T-test, Chi-square, and ANOVA for analytics. Carboxytherapy was performed by intradermal injection of 5 cc carbon-dioxide gas once weekly for six weeks. The PRP treatment was performed by intradermal injection of PRP in periorbital space using an insulin syringe every two weeks for three times. The periorbital darkness was assessed using visual analogue scale (VAS) preoperatively and within 8 weeks postoperatively by the patients and the dermatologists. Automatic assessments of skin vascularity and pigmentation were assessed using a digital camera. The patients represented significant darkness improvement postoperatively for both of the approaches (P-value: 0.84, P-value: 0.87), while the comparison of the two groups revealed insignificant postoperative changes by dermatologists assessments (P-value = 0.59, P-value: 0.61), the patients' assessments (P-value = 0.85), the digital camera skin vascularity and pigmentation assessments (P-value>0.05). Conclusion: Although insignificant changes following both of the approaches were found, it may have occurred due to the technique, quality of material, or inadequate treatment sessions due to the type of Iranian skin; therefore, more evaluations considering particular entities such as vascularity for longer duration of follow-up and new design are strongly recommended. This article is protected by copyright. All rights reserved.
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4.
The Addition of Tissue Stromal Vascular Fraction To Platelet-Rich Plasma Supplemented Lipofilling Does Not Improve Facial Skin Quality: A Prospective Randomized Clinical Trial
van Dongen JA, Boxtel JV, Willemsen JC, Brouwer LA, Vermeulen KM, Tuin AJ, Harmsen MC, van der Lei B, Stevens HP
Aesthetic surgery journal. 2021
Abstract
BACKGROUND Lipofilling has become popular as a treatment to improve aging related skin characteristics (eg, wrinkles, pigmentation spots, pores, or rosacea). Different additives such as platelet-rich plasma (PRP) or stromal vascular fraction (SVF) have been added to lipofilling to increase the therapeutic effect of adipose derived stromal cells (ASCs). OBJECTIVES In this study, we hypothesized that mechanical isolated SVF augments the therapeutic effect of PRP supplemented lipofilling to improve facial skin quality. METHODS This prospective, double-blinded, placebo-controlled, randomized trial was conducted between 2016 and 2019. In total, 28 female subjects were enrolled with 25 completing the follow-up. All patients received PRP supplemented lipofilling with either mechanical isolated SVF or saline. SVF was isolated by means of the fractionation of adipose tissue (FAT) procedure (tissue-SVF). Results were evaluated by changes in skin elasticity and transepidermal water loss, changes in skin aging related features, ie, superficial spots, wrinkles, skin texture, pores, vascularity, and pigmentation as well as patient satisfaction (FACE-Q), recovery, and number of complications up to 1 year postoperative. RESULTS The addition of tSVF to PRP supplemented lipofilling did not improve skin elasticity, transepidermal water loss nor skin aging related features. No improvement in patient satisfaction with overall facial appearance nor facial skin quality was seen when tSVF was added to PRP supplemented lipofilling. CONCLUSIONS PRP supplemented lipofilling with tSVF compared to PRP supplemented lipofilling alone does not improve facial skin quality nor patient satisfaction in a healthy population. PRP supplemented lipofilling with tSVF can be considered a safe procedure.
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5.
Treatment of Atrophic Acne Scars: Topical or intralesional plasma gel?
Moustafa Mohamed M, Sabry HH, Salem RM
Photodermatology, photoimmunology & photomedicine. 2021
Abstract
BACKGROUND Atrophic post acne scarring is considered to be a therapeutic challenge. OBJECTIVES The aim was to compare the safety and efficacy of A) FCL combined with intradermal injection of plasma gel, B) FCL combined with topical application of plasma gel, and C) FCL monotherapy in the treatment of atrophic postacne scars. METHODS Thirty patients with facial atrophic post-acne scars were enrolled in this study and randomly assigned into one of three groups. All of them underwent 4 treatment sessions at 4-weeks intervals. They were assessed objectively by the quantitative global scarring grading system (GSGS). This system was applied at baseline, and after 1- and 6-month follow-up (FU). Subjective assessments were performed through the global aesthetic improvement scale (GAIS) and level of patient satisfaction. The DLQI questionnaire was employed at the baseline and 6-month FU. RESULTS According to the quantitative GSGS scores, the reductions in group A (68.4%) and group B (63%) scores were comparable and both were significantly higher than that in group C (41.2%) in all steps of evaluation. At 6-month FU, both groups A and B showed further significant improvement while group C did not. Based on the GAIS and patients' satisfaction, there were no significant differences between all groups. The reductions in DLQI scores in groups A and B were comparable, however both were significantly higher than group C (p<0.001). CONCLUSIONS The combination of plasma gel and FCL resurfacing was noticeably outstanding in their efficacy and impact on the patients' quality of life.
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6.
Efficacy of platelet-poor plasma gel in combination with fractional CO(2) laser in striae distensae: A clinical, histological, and immunohistochemical study
Gad SE, Neinaa YME, Rizk OK, Ghaly NER
Journal of cosmetic dermatology. 2021;20(10):3236-3244
Abstract
BACKGROUND Platelet-poor plasma gel is a semi-solid plasma formulation that recently recommended as autologous bio-filler for treatment of atrophic dermal scars. AIM: To compare the therapeutic efficacy and safety of intradermal injection of plasma gel in combination with fractional CO(2) laser versus fractional CO(2) laser alone in striae distensae (SD). PATIENTS AND METHODS This study included 36 SD patients treated by three sessions (one session/1.5 months) of fractional CO(2) laser on all SD lesions following intradermal injection of plasma gel on one side and saline (as placebo) on the other side. RESULTS Significant clinical improvements associated with remarkable narrowing of SD lesions and prominent enhancement of skin texture were observed on both treatment sides. Obviously, higher degrees of clinical improvements of SD lesions were reported following combined therapy with fractional CO(2) laser and plasma gel rather than fractional CO(2) laser monotherapy. However, post-inflammatory hyperpigmentation (PIH) was reported more frequently with fractional CO(2) laser monotherapy. Histopathological and immunohistochemical examinations revealed significant epidermal improvement, and homogenization, and orientation of dermal collagen bundles as a result of both therapeutic procedures. CONCLUSION Plasma gel in combination with fractional CO(2) laser could be considered a promising novel treatment modality for SD. Plasma gel not only improves the efficacy of fractional CO(2) laser but also decreases the frequency of PIH.
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7.
The Effects of Lower Versus Higher Cell Number of Platelet-Rich Plasma (PRP) in Hair Density and Diameter in Androgenetic Alopecia (AGA): A Randomized, Double-Blinded, Placebo, Paralleled Group Half-Scalp IRB Study
Sasaki GH
Aesthetic surgery journal. 2021
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a common disorder in male and female patients that may benefit from the use of platelet-rich plasma. OBJECTIVES To compare the safety, efficacy, and satisfaction of a lower or higher number of platelets over 6 months. METHODS A prospective randomized, double-blinded, placebo, paralleled group, half-scalp IRB study among eight subjects with moderate AGA. Participants received intradermal PRP injections (baseline and month 3), according to two treatment protocols (high vs low platelet numbers) to the frontal and crown portions of the hemi-scalp and normal saline to control sites. Phototrichoscans were measured at baseline and six months, while global photography and subject and investigator satisfaction questionnaires were obtained at baseline, 3, and 6 months. RESULTS At the end of 6-month evaluation period, both groups demonstrated numerical increases in total hair densities, follicle diameters and terminal hair densities, as well as absolute and percent changes at the frontal and crown targeted sites compared to baseline. These improvements tended to occur more often in areas treated with higher platelet numbers than with lower numbers. Vellus hair densities did not exhibit any significant changes to either PRP dosages. Treatments were assessed by investigator and subjects as "satisfied" at month-3 and were associated with no adverse reactions. CONCLUSIONS Intradermal injections with two therapeutic quantities of platelets were equally safe and efficacious among men and women with androgenetic alopecia. Findings suggest that higher numbers of platelets may have a greater effect than lower number of platelets in regard to hair densities, follicle diameters and terminal hair densities but exhibited minimal effects on vellus hair densities at the month-6 evaluation period. Further studies are required to determine whether any significant advantages occur when delivering either lower or higher numbers of platelets in AGA treatments as long as therapeutic levels are administered.
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8.
Comparison of the Efficacy of Fractional Radiofrequency Microneedling alone and in combination with platelet rich plasma in neck rejuvenation a clinical and optical coherence tomography study
Gawdat H, Allam Rshm, Hegazy R, Sameh B, Ragab N
Journal of cosmetic dermatology. 2021
Abstract
BACKGROUND Aesthetic improvement of the neck and cervicomental angle remains one of the most challenging aspects of rejuvenation. Fractional radiofrequency microneedling demonstrated significant skin tightening and lifting of lower third of the face. AIM OF WORK To evaluate and compare fractional radiofrequency microneedling alone and in combination with autologous platelet rich plasma (PRP) in neck rejuvenation. METHODS 20 patients with mild to moderate neck laxity were randomized to receive 3 sessions of either fractional radiofrequency microneedling + PRP (group A) or fractional radiofrequency microneedling monotherapy (group B). Evaluation was done using optical coherence tomographgy to detect dermis thickness, measurement of cervicomental angle, a score done by two investigators blinded to used modality (GAIS) and patient satisfaction score. RESULTS Both Groups showed a statistically significant improvement in all parameters. Comparing the two groups the mean dermal thickness after treatment was higher in group A compared to B but was found statistically insignificant. More favorable results were reported in group A according to GAIS. Other parameters showed comparable results. CONCLUSION Fractional micro-needle radiofrequency with insulated microneedles offers a safe and effective modality for mild to moderate neck laxity when used alone or in combination with PRP. It remains questionable whether combining fr-RF microneedling with PRP provides more favorable results in terms of efficacy and side effects.
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9.
Evaluation of adding platelet-rich plasma to combined medical therapy in androgenetic alopecia
Ramadan WM, Hassan AM, Ismail MA, El Attar YA
Journal of cosmetic dermatology. 2021
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a common hair loss disorder. OBJECTIVES To evaluate the therapeutic effects of platelet-rich plasma (PRP) in androgenetic alopecia. METHODS This study was done on 126 AGA patients, 42 patients survived as control group who received medical treatment, only other 84 patients were subdivided into two groups, and they received PRP sessions as co-adjuvant therapy using different methods administration. Patients were evaluated clinically, by dermoscopy and by digital dermoscopy to measure hair density and diameters before and after treatment. RESULTS PRP-treated patients showed statistically significant increase in hair density and diameter measurements than control group. These results increased by using microneedling as a method of PRP administration. CONCLUSION In AGA, the addition of "PRP with microneedling" to the combined medical treatment increases its efficacy and shortens the time needed for optimum improvement. STUDY DESIGN Single-blinded randomized controlled study.
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10.
Improved wound healing of diabetic foot ulcers using human placenta-derived mesenchymal stem cells in gelatin electrospun nanofibrous scaffolds plus a platelet-rich plasma gel: A randomized clinical trial
Meamar R, Ghasemi-Mobarakeh L, Norouzi MR, Siavash M, Hamblin MR, Fesharaki M
International immunopharmacology. 2021;101(Pt B):108282
Abstract
AIM: The effectiveness of nanofibers containing human placenta-derived mesenchymal stem cells (hPDMSCs) plus platelet-rich plasma (PRP) for healing of diabetic foot ulcers (DFUs) was investigated. METHODS hPDMSCs were isolated from human donor placentas, and cultured in electrospun gelatin nanofibrous scaffolds (GNS). Twenty-eight patients with DFUs were randomized into three groups in a 12-week trial: (A) Treated with hPDMSCs; (B) Treated with hPDMSCs after coating the ulcer with PRP gel; (C) Control group received standard wound care. Wound area and pain freewalkingdistance were measured every 2 weeks. RESULTS Flow cytometry showed the expression of mesenchymal markers. SEM images and DAPI staining indicated significantly higher levels of hPDMSC proliferation on GNS after 3 and 7 days of culture. The MTS assay showed a significant increase in proliferation on GNS, compared to controls. Wound size reduction was 66% in group A, 71% in group B, and 36% in control group C. A significant difference in wound closure and pain-free walking distance was observed between groups A and B, compared to control group C (p < 0.05), but no difference between groups A and B. Biopsy of the implanted tissue showed the development of new capillary formation in groups A and B. CONCLUSION Implantation of hPDMSCs in GNS accelerated wound healing and improved clinical parameters in DFU patients.
