Abstract
Current biological treatments for non-healing wounds aim to address the common deviations in healing mechanisms, mainly inflammation, inadequate angiogenesis and reduced synthesis of extracellular matrix. In this context, regenerative medicine strategies, i.e., platelet rich plasmas and mesenchymal stromal cell products, may form part of adjuvant interventions in an integral patient management. We synthesized the clinical experience on ulcer management using these two categories of biological adjuvants. The results of ten controlled trials that are included in this systematic review favor the use of mesenchymal stromal cell based-adjuvants for impaired wound healing, but the number and quality of studies is moderate-low and are complicated by the diversity of biological products. Regarding platelet-derived products, 18 controlled studies investigated their efficacy in chronic wounds in the lower limb, but the heterogeneity of products and protocols hinders clinically meaningful quantitative synthesis. Most patients were diabetic, emphasizing an unmet medical need in this condition. Overall, there is not sufficient evidence to inform routine care, and further clinical research is necessary to realize the full potential of adjuvant regenerative medicine strategies in the management of chronic leg ulcers.
Highlights
The overwhelming costs of wound care services is rising worldwide [1,2], with the market of wound care products surpassing $15 billion according to Global Industry Analysts [3]
The question that we addressed is as follows: is there any mesenchymal stromal cell or platelet-based regenerative therapy that applied locally, either injected in the wound edges and/or applied topically in the wound bed, can help to heal chronic leg ulcers? The results of controlled trials included in this systematic review favor the use of mesenchymal cell based-adjuvants for impaired wound healing, but the number and quality of studies is moderate-low and complicated by the diversity of biological products
We identified 18 studies involving the use of platelets or platelet rich plasma (PRP) in chronic leg ulcers; they were published between 1986 and 2017 [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]
Summary
The overwhelming costs of wound care services is rising worldwide [1,2], with the market of wound care products surpassing $15 billion according to Global Industry Analysts [3]. Chronic wounds in the lower limb represent the largest fraction, with venous and diabetic foot ulcers (DFU)s accounting for 70–90% of these ulcers [4]. The socioeconomic and biomedical burdens that they represent are worsened by global demographic events, such as the aging population and the pandemic of obesity [5]. The latter is associated with an increased incidence of diabetes and the threat it involves in foot ulcer development. Up to 25% of diabetic patients will develop a foot ulcer with costs ranging from $7439 to $20,622 per episode [6]. Ulcer chronicity increases the severity and the costs of these conditions
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