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Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial
Kosaki, Y., Hongo, T., Hayakawa, M., Kudo, D., Kushimoto, S., Tagami, T., Naito, H., Nakao, A., Yumoto, T.
World journal of emergency surgery : WJES. 2024;19(1):1
Abstract
BACKGROUND The appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels. METHODS We performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low (< 2.5 mmol/L), middle (≥ 2.5 and < 4.0 mmol/L), and high (≥ 4.0 mmol/L). We compared 28 days mortality and ICU-free and ventilator-free days using multiple linear regression among groups. RESULTS Of the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury. CONCLUSIONS Our results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels.
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Efficiency of platelet-rich plasma in the management of burn wounds: A meta-analysis
Imam, M. S., Alotaibi, A. A. S., Alotaibi, N. O. M., Alosaimi, N. S., Alotaibi, S. G. M., Abdelrahim, M. E. A.
International wound journal. 2023
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Abstract
The meta-analysis aimed to assess the efficiency of platelet-rich plasma (PRP) in the management of burn wounds (BWs). Using dichotomous or contentious random- or fixed-effects models, the outcomes of this meta-analysis were examined and the odds ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) were computed. Thirteen examinations from 2009 to 2023 were enrolled for the present meta-analysis, including 808 individuals with BWs. PRP had significantly shorter healing time (MD, -5.80; 95% CI, -7.73 to -3.88, p < 0.001), higher healing rate (OR, 3.14; 95% CI, 2.05-4.80, p < 0.001), higher healed area percent (MD, 12.67; 95% CI, 9.79-15.55, p < 0.001) and higher graft take area percent (MD, 4.39; 95% CI, 1.51-7.26, p = 0.003) compared with standard therapy in patients with BW. However, no significant difference was found between PRP and standard therapy in graft take ratio (OR, 1.70; 95% CI, 0.86-3.34, p = 0.13) and infection rate (OR, 0.55; 95% CI, 0.20-1.47, p = 0.23) in patients with BW. The examined data revealed that PRP had a significantly shorter healing time, a higher healing rate, a higher healed area percent and a higher graft take area percent; however, no significant difference was found in graft take ratio or infection rate compared with standard therapy in patients with BW. Yet, attention should be paid to its values since all of the selected examinations had a low sample size and some comparisons had a low number of selected studies.
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Effect of platelet-rich plasma in treating patients with burn wounds: A meta-analysis
Lin, C., Xin, L., Xie, S.
International wound journal. 2023
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Abstract
A meta-analysis was conducted to investigate the effects of platelet-rich plasma (PRP) in the treatment of burn wounds and to provide a scientific basis for clinical drug therapy. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases to identify randomised controlled trials (RCTs) on PRP in treating burn wounds, with the control group being treated with conventional treatments and the intervention group being treated with PRP alone or combined with PRP on the basis of the control group. The search duration was each database's inception to September 2023. The literature was screened, data were extracted and quality was assessed by two independent researchers. Data analysis was performed using the Review Manager 5.4 software. Eighteen RCTs comprising 1463 patients were included in the analysis. The meta-analysis revealed that the application of PRP significantly improved the wound healing rate (standardised mean difference [SMD]: 1.11, 95% confidence interval [CI]: 0.54-1.67, p < 0.001), shortened wound healing time (SMD: -1.69, 95% CIs: -2.21 to -1.17, p < 0.001) and reduced the incidence of adverse events (7.03% vs. 18.93%, odds ratio [OR]: 0.32, 95% CI: 0.20-0.53, p < 0.001), and also significantly reduced patients' pain (SMD: -1.86, 95% CI: -2.47 to -1.25, p < 0.001) of burn patients when compared with the control group. This study showed that PRP is effective in repairing burn wounds, promoting wound healing, reducing the incidence of adverse events and reducing patient pain, making it worthy of clinical promotion and application.
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Platelet to erythrocyte transfusion ratio and mortality in massively transfused trauma patients. A systematic review and meta-analysis
Rijnhout TWH, Duijst J, Noorman F, Zoodsma M, van Waes O, Verhofstad MHJ, Hoencamp R
The journal of trauma and acute care surgery. 2021
Abstract
BACKGROUND Platelet transfusion during major hemorrhage is important and often embedded in massive transfusion protocols. However, the optimal ratio of platelets to erythrocytes (platelet rich plasma (PLT) :RBC ratio) remains unclear. We hypothesized that high PLT:RBC ratios, as compared to low PLT:RBC ratios, are associated with improved survival in patients requiring massive transfusion. METHODS Four databases (Pubmed, CINAHL, EMBASE and Cochrane) were systematically screened for literature published up to January 21, 2021 to determine the effect of PLT:RBC ratio on the primary outcome measure mortality at 1-6 and 24 hours and at 28-30 days. Studies comparing various PLT:RBC ratios were included in meta-analysis. Secondary outcomes included intensive care unit length of stay and in-hospital length of stay and total blood component use. The study protocol was registered in PROSPERO under number CRD42020165648. RESULTS The search identified a total of 8903 records. After removing duplicates second screening of title, abstract and full text a total of 59 articles were included in the analysis. Of these articles 12 were included in meta-analysis. Mortality at 1-6, 24-hours and 28-30 days was significantly lower for high PLT:RBC ratios as compared to low PLT:RBC ratios. CONCLUSIONS Higher PLT:RBC ratios are associated with significantly lower 1-6 hours, 24 hours, 28-30 days mortality as compared to lower PLT:RBC ratios. The optimal PLT:RBC ratio for massive transfusion in trauma patients is approximately 1:1. LEVEL OF EVIDENCE Systematic review and meta-analysis, therapeutic level III.
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Platelet-rich plasma for the treatment of burn wounds: A meta-analysis of randomized controlled trials
Huang, H., Sun, X., Zhao, Y.
Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis. 2021;60(1):102964
Abstract
BACKGROUND To evaluate the efficacy and safety of platelet-rich plasma in the treatment of burn wounds through a meta-analysis of randomized controlled trials. METHODS We conducted a comprehensive study from electronic medical journal databases. The primary outcome was healing rate, and the secondary outcomes were healing time, adverse events, pain score and scar score. The data was analyzed using Review Manager 5.3 and Stata 12. The odds ratio (OR) among different groups was calculated by using 95 % confidence interval (CI). RESULTS We included 8 randomized controlled trials with a total of 539 patients. The results showed that platelet-rich plasma could improve the healing rate of burn wound (OR 4.43, 95 % CI 2.13-9.22). The wound healing time of the platelet-rich plasma treatment group was significantly shorter than that of the conventional treatment group (OR -4.23, 95 % CI -5.48 to -2.98), both the superficial burn (OR -3.80, 95 % CI -4.53 to -3.07) and the deep burn group (OR -4.65, 95 % CI -6.90 to -2.40) had shorter healing time. Otherwise, the incidences of adverse events (OR 0.30, 95 % CI 0.11-0.78), pain score (OR -0.80, 95 % CI -1.40 to -0.21) and scar score (OR -0.38, 95 % CI -0.69 to -0.07) were all better in the platelet rich plasma treatment group. CONCLUSION Topical platelet-rich plasma treatment on burn wounds can improve wound healing and reduce the incidence of adverse events. Further research is needed to standardize the preparation and use of platelet-rich plasma and to evaluate the long-term clinical outcome of platelet-rich plasma in the treatment of burn wounds.
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Effectiveness of platelet rich plasma in burn wound healing: A systematic review and meta-analysis
Zheng W, Zhao DL, Zhao YQ, Li ZY
The Journal of dermatological treatment. 2020;:1-25
Abstract
Background: To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of burn wounds.Methods: A comprehensive literature survey was conducted in electronic medical journal databases to identify studies that examined the effect of PRP treatment to burn wounds and meta-analyses of mean differences (MD) standardized MD, or odds ratios (OR) were performed.Results: The percentage of graft take was not significantly different between PRP-treated and control wound areas. Healing rate was significantly better in PRP-treated wounds. Healing time was also significantly less in PRP-treated wounds. There was no significant difference between PRP-treated and control wound areas in epithelialization, or in the incidence of adverse events. Incidence of infection was also not different between PRP-treated and control wound areas. Scar assessment score was significantly better in PRP-treated than in control wound areas.Conclusion: PRP treatment to burn wounds is found to improve healing. Variations in study design and sample size, types of wounds, PRP preparation protocols, and high risk of bias in some of the included studies may have impact on these outcomes.
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Evaluation of the Effect of Platelet-Rich Fibrin on Wound Healing at Split-Thickness Skin Graft Donor Sites: A Randomized, Placebo-Controlled, Triple-Blind Study
Vaheb M, Karrabi M, Khajeh M, Asadi A, Shahrestanaki E, Sahebkar M
The international journal of lower extremity wounds. 2020;:1534734619900432
Abstract
Split-thickness skin grafting (STSG) is widely used to heal wounds resulting from trauma, burns, and chronic wounds. This study aimed to determine the true effect of platelet-rich fibrin (PRF) on patients with burn wounds requiring STSG during treatment of donor wounds. This randomized, triple-blind clinical trial was conducted on patients who referred to the burn ward of Vasei Hospital of Sabzevar, Iran, from May 2017 to May 2018. The donor site was randomly divided into 2 groups: PRF and control (Vaseline petrolatum gauze) using Vaseline gauze. In the intervention group, the PRF gel was applied to the wound and covered with Vaseline gauze and wet dressing. Conversely, only Vaseline gauze and wet dressing were applied to the control group. Outcome evaluation was conducted using paired t test and Wilcoxon signed rank-sum test, as appropriate, on days 8 and 15. The mean age of the patients was 33.10 +/- 2.60 years, and 51.50% were male. The mean wound healing time in the PRF and control groups was 11.80 +/- 3.51 and 16.30 +/- 4.32 days, respectively (P < .001). The PRF group showed significantly higher wound healing rates than the control group at 8 and 15 days dressing (P < .001 and P < .001, respectively). Moreover, the mean wound healing for all wound healing indices diagnosed by 2 specialists in PRF was higher than control group on days 8 and 15 (P < .001). We found a statistically significant difference on days 8 and 15 regarding the mean pain levels between the 2 groups (P < .001). The findings showed that PRF can significantly increase the time and rate of donor wound healing compared with conventional treatment and also reduce the severity of pain.
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Autologous Platelet Rich Plasma As A Preparative for Resurfacing Burn Wounds with Split Thickness Skin Grafts
Gupta S, Goil P, Thakurani S
World J Plast Surg. 2020;9(1):29-32
Abstract
BACKGROUND Split thickness skin graft is a widely accepted technique to cover large defects. Shearing, hematoma and infection have often been attributed as major causes for graft loss. Autologous platelet rich plasma (PRP) has been used in various treatment modalities in the field of plastic surgery for its healing, adhesive and hemostatic properties owing to the growth factors that are released. This Study primarily throws light on the usage of PRP over difficult Burn wound beds to augment graft uptake and attenuate complications. METHODS The patients were divided into two groups of those who were subjected to use of autologous PRP as a preparative burn surfacing and the control group who underwent standard method of treatment. RESULTS Patients in PRP group significantly showed a higher graft adherence rate as compared to those with other method. It also reduced pain, and hematoma formation. CONCLUSION Application of PRP is a safe, cost effective, easy method to increase graft adherence rate in patients with burns where graft loss is noticed and there is shortage of donor sites.
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The Effectiveness of Autologous Platelet Rich Plasma Application in the Wound Bed Prior to Resurfacing with Split Thickness Skin Graft vs. Conventional Mechanical Fixation Using Sutures and Staples
Dhua S, Suhas TR, Tilak BG
World journal of plastic surgery. 2019;8(2):185-194
Abstract
BACKGROUND Autologous platelet rich plasma (PRP) has significant benefits facilitating improved graft take on wound beds due to hemostasis, adhesive and healing properties. This study aimed at effective use of PRP in wound beds on graft take irrespective of etiology as compared to conventional methods of mechanical fixation using sutures and staples. METHODS Forty cases including 20 in control and 20 in PRP groups admitted to the Department of Plastic Surgery at Vydehi Institute of Medical Sciences and Research Centre, Bangalore were enrolled between October 2015 and September 2017. Freshly prepared autologous PRP was applied on wound beds in the treated group, while conventional mechanical fixation methods like staples and sutures were used in the control group for the fixation of the skin grafts. RESULTS Most significant result was the instant graft take to the wound bed irrespective of the etiology besides hemostasis and healing properties in the PRP treated group which resulted in considerable reduction of surgeon's time required for the removal of sutures and staples at the final stages. Also, only 10% with graft edema were noted in the PRP treated patients as compared to 68% in the control group. The inner dressings and skin graft were dry in the PRP group and the post-operative etching, weeping and pain at the graft site reduced. CONCLUSION The cosmetic appearance of this scar was better in the PRP group besides post-operative edema and graft loss. The study recommends use of PRP at the recipient site of split thickness skin graft.
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The effect of mesenchymal stem cells combined with platelet-rich plasma on skin wound healing
Mahmoudian-Sani M R, Rafeei F, Amini R, Saidijam M
Journal of Cosmetic Dermatology. 2018;17((5):):650-659
Abstract
INTRODUCTION Mesenchymal stem cells (MSCs) are multipotent stem cells that have the potential of proliferation, high self-renewal, and the potential of multilineage differentiation. The differentiation potential of the MSCs in vivo and in vitro has caused these cells to be regarded as potentially appropriate tools for wound healing. After the burn, trauma or removal of the tumor of wide wounds is developed. Although standard treatment for skin wounds is primary healing or skin grafting, they are not always practical mainly because of limited autologous skin grafting. EVIDENCE ACQUISITIONS Directory of Open Access Journals (DOAJ), Google Scholar, PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched. EVIDENCE SYNTHESIS For clinical use of the MSCs in wound healing, two key issues should be taken into account: First, engineering biocompatible scaffolds clinical use of which leads to the least amount of side effects without any immunologic response and secondly, use of stem cells secretions with the least amount of clinical complications despite their high capability of healing damage. CONCLUSION In light of the MSCs' high capability of proliferation and multilineage differentiation as well as their significant role in modulating immunity, these cells can be used in combination with tissue engineering techniques. Moreover, the MSCs' secretions can be used in cell therapy to heal many types of wounds. The combination of MSCs and PRP aids wound healing which could potentially be used to promote wound healing.