PII: 0741-5214(92)90431-7

Abstract

The article by Krupski et al.1Krupski WC Reilly LM Perez S Moss KM Crombleholme PA Rapp JH A prospective randomized trial of autologous platelet-derived wound healing factors for the treatment of chronic nonhealing wounds: a preliminary report.J Vasc Surg. 1991; 14: 526-532Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar on platelet-derived wound healing factors (PDWHF) must be put in perspective. It is important to do trials such as this to look at the efficacy of therapeutic modalities; however, this is a skewed very small sample and the statement “… we cannot recommend use of PDWHF in the elderly dysvascular patients …” does not appear warranted by their data. If one looks at this study, the “dysvascular patient” was not adequately treated. Autologous PDWHF are not a substitute for vascular surgery. They are meant to be an adjunctire treatment in a total picture of comprehensive wound care. We looked at our 12-month experience on the peripheral vascular service from April 1990 to March 1991 using PDWHF. Sixtyseven wounds were treated in 54 limbs with PDWHF. The average previous duration of the wound was 13.6 months, and the average wound volume was 8.19 cm3. Our initial duration is more than twice as long as this reported study (placebo 4.3 months, PDWHF 6.2 months), and the size of our initial wound volume is more than four times theirs (placebo 2.0 cm3, PDWHF 1.4 cm3). Diabetes mellitus was present in 80% of our patients as in their study. There are two major differences seen here, the first is that patients with hypoperfused wounds are often not healing because of low oxygenation. A normal tcPO2 is above 50 mm Hg. Our general criterion for revascularization is a tcPO2 less than 35 mm Hg on the closest intact periwound skin. In the study by Krupski et al. the average tcPO2 was 37 mm Hg. Our average tcPO2 was above 50 mm Hg at the time of applying PDWHF, and it was applied because the wound still would not heal despite adequate perfusion. Revascularization was done in 43% of our patients (23 of 54) as compared with 50% (4 of 8) in the placebo and only 25% (2 of 8) in the PDWHF group. The second major difference is that the potency of thc PDWHF was checked with b-thromboglobulin in our patients and it was not in Dr. Krupski's study. Healing occurred in 79% of our wounds (53 of 67) in an average of 12 weeks. Fourteen of our patients did not heal; three were due to low perfusion that could not be corrected, and two went on to above-knee amputation. Eleven patients appeared not to heal because of noncompliance of the patient (would not apply the PDWHF properly or would not stay offofa plantar wound while healing). Limb salvage was 96% (52 of 54) in our patients. Chronic nonhealing wounds of the legs and feet may lead to further breakdown, infection, and/or amputation. After adequate revascularization, in our experience, active PDWHF is able to cover large areas including tendon and/or bone on the dorsum of the foot and heel. Our retrospective review indicates that further studies are indicated, but that use of the PDWHF should continue in the dysvascular patient with further refinements and selection.