The Role of Topical Autologous Plasma Rich Membranes in Healing Diabetic Foot Ulcers Editorial Summary This article provides a short and concise overview of bedside treatment of Diabetic Foot Ulcers (DFUs) using an Autologous Plasma Rich in Growth Factors Membrane in clinical practice.
Introduction
among others.
D
iabetic Foot Ulcers (DFUs) are common and are a major source of disability, distress, and cost. DFUs are difficult to heal because of poor vascularity and impaired sensation resulting from sensory neuropathy. There are around 7,000 lower limb amputations in diabetes patients in England each year, and the likelihood that someone with diabetes will have a leg, foot or toe amputation is around 23 times that of a person without diabetes.
Why Use Autologous Membranes?
Plasma
Rich
In recent years there is great interest in the use of autologous platelet rich products for use in DFUs. Topical growth factor products are typically used as adjuvant treatments along with the standard care for treatment of diabetic foot ulceration with successful results. Endoret® PRGF® (Plasma Rich Growth Factors) uses advanced biomedical technology to stimulate tissue regeneration with the use of autologous proteins found in the blood. The Endoret® PRGF® technique involves a simple bedside procedure to obtain a platelet concentrated fibrin membrane rich in autologous growth factors, which acts as a biological membrane. Endoret® PRGF® preparation was shown to have higher levels of most growth factors which help in biological wound healing. This preparation has demonstrated its effectiveness in multiple medical fields including dentistry, oral implantology, opthalmology and orthopedics,
58
Wound Masterclass - Vol 1 - June 2022
To improve wound healing and to accelerate the epithelization of chronic wounds, we applied the Endoret® technique on diabetic patients with chronic, non-healing DFUs to test PRGF clot membrane therapy. The Endoret® technique consists of a single treatment. Venous blood was obtained and collected using the Endoret® PRGF® protocol in 9ml sterile tubes containing 3.8% (wt/v) Sodium Citrate (SC). Using Endoret® patented technology, the blood was centrifuged for 8 minutes at room temperature using the Endoret® PRGF® system centrifuge to obtain PRGF. The PRGF was drawn off in 2 fractions, labelled F1 and F2. F1 was injected around the wound margins. Two millilitres of F2, which contains the optimal concentration of platelets (2-3x) isolated above the erythrocytes and leucocytes, was drawn up using the Plasma Transfer Device (PTD). F2 was then activated using Calcium Chloride (CC). Upon completion of the Endoret® protocol, a fibrin clot was formed and placed over the bed of the ulcer, and the remaining F2 was infiltrated around the edges of the wound. Adequate dressing was secured, and the patient kept non-weight-bearing. Subsequent follow-ups were done in the clinic at 2 weekly intervals for examination of the wound, dressing and medical photography by a trained nurse. In all cases, the entire procedure took under 1 hour. Patients were followed up until the end point was achieved, which was defined as full epithelization of ulcer without drainage.
Prof Anand Pillai Consultant Orthopaedic Foot & Ankle and Adult Reconstruction Surgeon Manchester, United Kingdom
Mr Noman Niazi Manchester University Hospitals NHS Foundation Trust Manchester, United Kingdom
The Role of Topical Autologous Plasma Rich Membranes in Healing Diabetic Foot Ulcers
“Successful treatment of DFUs may decrease further diabetic complications including amputations and ultimately mortality.”
All patients achieved full epithelization of the ulcers with no adverse events or complications observed throughout the treatment. PRGF therapy has been successfully used to promote tissue regeneration and has been employed in the treatment of multiple musculoskeletal disorders and regeneration of tissue healing. In recent years, several studies have reported the effects of different plateletrich products in diabetic ulcers, obtaining successful results in ulcer healing. One Randomised Control Trial (RCT) of autologous platelet gel reported benefit in time to complete ulcer closure at 12 weeks in comparison with standard care. A recent multicentric RCT showed clinically and statistically significant benefit with the application of autologous immune cell, fibrin, and platelet patches for DFUs.
Conclusion Endoret® PRGF® offers many distinct advantages over traditional platelet rich plasma (PRP) therapy by creating a more rapid and natural healing response. Hundreds of endogenous proteins stimulate the tissue repair processes, which include new blood vessel formation, cell mobilization and cell proliferation. It also provides a safe and excellent vehicle for local growth factor delivery, functioning as a provisional matrix that supports the ingrowth of neovasculature and the migration of cells into the ulcer dead space, regenerating surrounding soft tissues. This single treatment is a useful adjuvant to skin dressings for DFUs to improve outcome and decrease serious complications. Successful treatment of DFUs may decrease further diabetic complications including amputations and ultimately mortality.
Wound Masterclass - Vol 1 - June 2022
59
May - June 2022