Successful Management of Diabetic Foot Ulcer Complicated by Osteomyelitis Using Platelet-Rich Plasma Therapy: A Case Report.

Diabetic foot ulcers: treatment overview and cost considerations.

Background: Foot infections and ulceration are the most frequent reason for hospitalization in patients with diabetes mellitus (DM), accounting for up to 25% of all patients with DM admission. In the new advanced therapies for treating diabetic foot ulcers (DFUs), platelet-rich plasma (PRP) and negative pressure wound therapy (NPWT) have shown promising results. Aims and Objectives: The objectives of the study are as follows: To study the role of NPWT and PRP in management diabetic foot wounds and to compare granulation tissue formation, total duration of wound healing, and hospital stay between two therapies in diabetic foot wounds. Materials and Methods: This study was conducted with 100 patients of diabetic foot wounds meeting the inclusion criteria with pre-structured proforma and written informed consent for the therapies. After surgical debridement of the wound, the enrolled patients were randomized into two groups to receive either PRP therapy (Group A) (n=50) or NPWT (Group B) (n=50). Results: PRP and NPWT both were effective in healing process of diabetic foot patients. The mean value of Group A in granulation tissue score were 2.10±0.73 and 1.90±0.60 in Group B showed no significant difference. The duration of hospital stay was lower in Group A as compared to Group B that is 19.04±4.85 days in Group A and 35.86±7.35 days in Group B. The total duration of wound healing in Group A was longer that is 7.22±3.34 weeks in Group A and Group B was 4.0±2.27 weeks. Conclusion: PRP (Group A) and NPWT (Group B) are novel tools in management of DFUs. PRP is more simple, more safe, less costly, less equipment requirement, less complication, shorter time for the method, less painful, less hospital stay, and autologous nature in the preparation and had proved the superiority over NPWT.

Background: Foot infections and ulceration are the most frequent reason for hospitalization in patients with diabetes mellitus (DM), accounting for up to 25% of all patients with DM admission. In the new advanced therapies for treating diabetic foot ulcers (DFUs), platelet-rich plasma (PRP) and negative pressure wound therapy (NPWT) have shown promising results. Aims and Objectives: The objectives of the study are as follows: To study the role of NPWT and PRP in management diabetic foot wounds and to compare granulation tissue formation, total duration of wound healing, and hospital stay between two therapies in diabetic foot wounds. Materials and Methods: This study was conducted with 100 patients of diabetic foot wounds meeting the inclusion criteria with pre-structured proforma and written informed consent for the therapies. After surgical debridement of the wound, the enrolled patients were randomized into two groups to receive either PRP therapy (Group A) (n=50) or NPWT (Group B) (n=50). Results: PRP and NPWT both were effective in healing process of diabetic foot patients. The mean value of Group A in granulation tissue score were 2.10±0.73 and 1.90±0.60 in Group B showed no significant difference. The duration of hospital stay was lower in Group A as compared to Group B that is 19.04±4.85 days in Group A and 35.86±7.35 days in Group B. The total duration of wound healing in Group A was longer that is 7.22±3.34 weeks in Group A and Group B was 4.0±2.27 weeks. Conclusion: PRP (Group A) and NPWT (Group B) are novel tools in management of DFUs. PRP is more simple, more safe, less costly, less equipment requirement, less complication, shorter time for the method, less painful, less hospital stay, and autologous nature in the preparation and had proved the superiority over NPWT.

Background/Objectives: Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes, often leading to infection, amputation, and reduced quality of life. Platelet-rich plasma (PRP) therapy has emerged as a promising treatment due to its potential to accelerate wound healing through growth factors and cytokines. Despite growing interest, evidence on PRP’s efficacy and safety in DFU management remains variable. This article critically reviews recent studies to evaluate the effectiveness of PRP in promoting ulcer healing, while examining methodological rigor, ethical considerations, and research parameters to provide a comprehensive, evidence-based assessment for clinical application. Materials and Methods: This review explores the biological mechanisms underlying platelet-rich plasma (PRP) as an adjunctive therapy for DFUs, focusing on its regenerative capabilities. PRP is an autologous concentration of platelets containing growth factors and bioactive molecules that promote angiogenesis, cellular proliferation, and extracellular matrix remodeling. Various application methods—topical, injectable, gel-based, and PRP-enhanced dressings—are examined. The review also evaluates the efficacy of PRP as monotherapy and in combination with other interventions such as debridement and split-thickness skin grafting. Results: Clinical studies suggest that PRP, particularly when used alongside surgical debridement or skin grafting, significantly enhances healing outcomes in patients with non-healing DFUs. It provides a biologically favorable environment for tissue regeneration while reducing inflammation and potentially exhibiting antimicrobial properties. However, variability in PRP preparation techniques, application protocols, and patient selection criteria presents challenges to standardization and broader clinical adoption. Conclusions: While PRP therapy demonstrates significant potential in the management of diabetic foot ulcers, further randomized controlled trials with standardized methodologies are essential to establish optimal treatment protocols and confirm long-term benefits. PRP offers a minimally invasive, autologous, and biologically active treatment modality that may serve as a vital component in the multidisciplinary approach to DFU management.

Platelet-rich plasma (PRP) has been proposed as an adjunct for the treatment of foot ulcers in patients with diabetes, as well as a treatment for chronic and acute wounds. This study examined the application of PRP in the treatment of diabetic foot ulcers (DFUs) in patients. This prospective study was conducted between 2011 and 2014. We used PRP, produced by a kit, for the treatment of DFUs. Patients were allocated to one of three groups, according to size of ulcer. The significance of changes in time for wound healing were statistically assessed. The study was completed by 150 patients, and a total of 150 foot ulcers were assessed. Wound size reduction was detected in patients after four weeks of treatment. In DFUs with a 2-5.5 cm2 surface area, complete closure happened after 7.2 weeks, 5.5-8.5cm2 DFUs completely closed after 7.5 weeks, and 8.5-12.5cm2 DFUs healed completely after 8.8 weeks. None of the wounds reopened after eight months of monitoring. This study will provide more evidence for the use of autologous PRP for DFUs in patients.

Background: Diabetic foot ulcers (DFUs) remain a major complication of diabetes, characterized by impaired wound healing, high infection risk, and an increased likelihood of limb amputation. Platelet-rich plasma (PRP) has emerged as a promising adjunctive therapy due to its regenerative properties, promoting angiogenesis, modulating inflammation, and accelerating tissue repair. Methods: This literature review explores the current evidence regarding the use of PRP in the management of DFUs. It was conducted using the PubMed database to evaluate the efficacy of PRP in DFUs. The search was restricted to studies published in the last 10 years, including randomized controlled trials, meta-analyses, and systematic reviews. The inclusion criteria focused on studies assessing PRP as a standalone treatment or in combination with other wound care strategies, evaluating key clinical outcomes such as wound healing rates, infection control, tissue regeneration, and amputation prevention. Results: A total of 35 studies met the inclusion criteria, including 11 meta-analyses, 15 review articles, and 9 clinical trials. PRP demonstrated potential benefits in accelerating wound healing, reducing inflammation, and promoting granulation tissue formation. Additionally, PRP combined with negative-pressure wound therapy (NPWT) showed superior outcomes in reducing amputation rates. However, findings varied based on patient characteristics, PRP preparation techniques, and treatment protocols. Conclusions: PRP represents a valuable adjunct in DFU management, contributing to improved healing outcomes and reduced complications. However, the lack of standardized protocols and variability in clinical results highlight the need for further large-scale, multicenter studies to establish its definitive role in diabetic wound care.

This meta-analysis aims to assess the efficacy and safety of platelet-rich plasma (PRP) through topical application and local injection methods compared to conventional care in patients with diabetic foot ulcers (DFU). A comprehensive literature search was conducted across PubMed, Embase, and Web of Science databases up to November 2024. Randomized controlled trials evaluating the efficacy and safety of PRP versus conventional care in DFU patients were included. Pooled weighted mean differences (WMD) and risk ratios (RR) were calculated with 95% confidence intervals. Fifteen randomized controlled trials (1,010 patients) were included. The PRP group showed significantly improved complete healing rates compared to conventional care (RR: 1.53, 95% CI: 1.39-1.58, P < 0.001), with comparable effectiveness between topical application and local injection methods (P = 0.57). Notably, PRP demonstrated a shorter healing time compared to conventional care (WMD: -19.48 days, 95% CI: -27.91 to -11.05, P < 0.001). The PRP group exhibited lower wound infection rates and amputation rates (RR: 0.51, 95% CI: 0.35 to 0.75, P < 0.001; RR: 0.45, 95% CI: 0.26 to 0.79, P = 0.005). The PRP group did not lead to a higher incidence of treatment-related adverse events compared to conventional care (RR: 0.80, 95% CI: 0.05 to 12.30, P = 0.87). This meta-analysis confirms that PRP application, both topically and via local injection, improves the complete healing rate, reduces healing time, infection rates, and amputations, without increasing adverse events. These findings support the integration of PRP into clinical practice for the management of diabetic foot ulcers.

Background: Diabetic foot ulcers (DFU) are one of the major complications of diabetes. Despite proper insulin treatment and a strict diabetic diet, 15% of diabetic population develop non-healing ulcers which leads to amputation of the lower limb. Wound dressings represent a part of the management of diabetic foot ulceration. Normal saline (0.9%) wound dressings have been a useful adjunct in the treatment of open wounds. Topical insulin dressing improves wound healing by regulating oxidative and inflammatory responses. PRP dressing has emerged as an adjunctive and newer method for treating DFUs. Hence, the present study was undertaken to compare the effect of topical insulin, platelet-rich plasma (PRP), and normal saline dressing in healing of DFU. Aims and Objectives: The aim of the study was to study the comparison between topical application of insulin versus PRP versus regular normal saline dressing in healing of DFU. Materials and Methods: It is a duration based prospective comparative study including 60 patients divided equally into normal saline dressing group, topical insulin dressing group and PRP dressing group after they fulfilled all the inclusion and exclusion criteria and after obtaining the proper informed and written consent from relatives/patients. Ulcers at days 0, 7 and 14 in terms of size, depth and percentage reduction in area of wound were analyzed. Results: The mean ulcer size at day 14 in normal saline was 4.19±0.95, in Insulin 2.64±0.83 while 2.08±0.47 in PRP group. The mean ulcer depth at day 14 in normal saline was 5.35±1.18, in insulin 4.30±1.38 while 2.35±1.42 (mm) in PRP group, percentage reduction of mean ulcer size in normal saline was 27.02±4.46, in insulin 50.31±7.53 and 63.80±5.75% in PRP group. Conclusion: PRP appears to be a promising agent in terms of faster wound healing, more significant reduction in the size of DFU as compared to topical insulin and other conventional dressings.

Background and objectives Diabetic foot ulcers (DFUs) present significant challenges due to their chronicity and potential complications. This study aims to compare the efficacy of platelet-rich plasma (PRP) versus normal saline dressing (NSD) in promoting wound healing and reducing complications among diabetic patients. Materials and methods This comparative study enrolled diabetic patients with foot ulcers, randomly assigned to either PRP or NSD treatment groups. Demographic data, ulcer characteristics, and treatment outcomes were meticulously recorded and analyzed. Statistical tests, including paired and independent samples t-tests, chi-square tests, and descriptive statistics, were employed to assess differences between the groups. Results Both groups exhibited similar age distributions, with PRP showing a slightly wider range. Sex distribution was identical between the NSD and PRP groups. PRP therapy demonstrated significant wound size reduction compared to NSD, with notable improvements in ulcer healing rates and reduced rates of complications and surgical interventions. Microbiological analysis revealed comparable infection rates between groups, with PRP potentially reducing infection-related complications. Interpretation and conclusion PRP therapy appears to offer superior efficacy over NSD in promoting DFU healing, as evidenced by substantial reductions in ulcer size and lower rates of complications. This study supports PRP as a promising treatment modality for DFUs, potentially enhancing clinical outcomes and reducing healthcare burdens.

Introduction: Effective wound care is crucial in managing diabetic foot ulcers (DFU), with practices such as wound cleaning and maintaining moisture being essential. The total-contact cast (TCC) is a recognized and effective method for off-loading plantar ulcers. This study compares the effectiveness of platelet-rich plasma (PRP) and normal saline (NS) dressings, both combined with TCC, in the treatment of DFUs. Methods: A total of 108 patients with diabetic foot ulcers were randomly divided into three groups: PRP, NS, and TCC, with 36 patients in each group. The PRP group received autologous PRP followed by TCC application, the NS group received wet NS dressings followed by TCC application, and the TCC group had TCC alone. Patients were followed every 15 days for 90 days, with wound measurements taken and TCC reapplied at each visit. Wound healing was assessed based on the time to heal and the PUSH score. Results: Baseline wound sizes were similar across groups, but by day 90, the PRP group showed a greater reduction in wound size (0.61±1.20) compared to the NS (1.58±1.55) and TCC groups (1.22±1.34). The PRP group also had the most significant improvement in PUSH scores, indicating superior wound healing. Conclusion: PRP, NS, and TCC are all effective in DFU treatment, but PRP combined with TCC is statistically superior in enhancing wound healing and reducing the frequency of hospital visit.

Platelet-rich plasma (PRP) has been recognized as a method of treatment in medicine since the 1980s. It primarily functions by releasing cytokines and growth factors that promote wound healing; these growth-promoting factors released by PRP enact new processes such as angiogenesis, collagen deposition, and tissue formation that can change wound-healing outcomes. Many studies recognize that PRP aids in chronic wound healing, which is advantageous for patients who suffer from chronic diabetic foot ulcers (DFUs). This scoping review aims to examine the literature to identify the efficacy of PRP use in the healing of DFUs. The objective of this study is to explore whether PRP has a beneficial effect on healing completeness and the rate of healing on DFUs. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched randomized-controlled trials involving PRP use in diabetic patients with foot ulcers using PubMed, Medline, CINAHL Complete, and Cochrane Database of Systematic Reviews. We restricted the search to articles published during 2005-2022, full texts in the English language, articles involving patients aged 19 years or older, articles that used PRP specifically on DFUs, articles that included a control group, and articles with human subjects. The initial search yielded 119 articles after removing duplicates. The final analysis for relevance yielded eight articles. In seven of the eight studies, the PRP group showed significant results, with either faster healing, more complete healing, or a larger percentage of healed participants. In the one study that did not give conclusive evidence of accelerated healing with PRP, PRP was used as an adjunct to fat grafting and only used once. Application styles of PRP for treatment were shown to influence the level of healing in patients, with injected PRP appearing to achieve the best results compared to topical PRP application. However, this was not conclusive due to the involvement of several other variables. Two studies additionally found PRP to be useful in healing refractory DFUs, and one study found that PRP use in patients with additional comorbidities was still more effective in healing DFUs than standard wound control. This study used scoping review methodology with randomized-controlled trials to examine the literature regarding PRP use in the healing of DFUs. The evidence suggests that PRP is a useful tool in reducing healing times and improving rates of complete wound healing in DFUs. There is room for further research in the application styles of PRP before conclusive statements can be made on the efficacy of injected versus topical PRP healing, based on the findings in this study. The results of this review provide a baseline for further research on PRP use in patients with diabetes and can be used by physicians and public health experts to guide future treatment options for DFUs.

The diabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, which occurs in 15-25% of diabetic patients at some point in their lives. However, most of the Diabetic foot ulcers (DFUs) do not heal with conventional methods of wound care and progress to become chronic, non-healing ulcers with high morbidity, mortality, and economic stakes. Some of the recent techniques in the management of ulcers include Systemic Hyperbaric Oxygen Therapy (s-HBOT), Platelet-Rich Plasma (PRP), Vacuum-Assisted Closure (VAC) Therapy, and Negative Pressure Wound Therapy (NPWT) that aim at improving the ulcer healing rate and minimize the risks of amputation. This work intends to conduct a comprehensive meta-analysis of the effectiveness, healing time and effect on amputation of these advanced treatment modalities on management of DFUs. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the reporting of systematic reviews and meta-analysis of randomized controlled trials. Information was obtained from 10 researches that considered different types of DFU treatment. The major end-points studied were rates of ulcer healing, time to heal and frequency of lower extremity amputations. The meta-analysis was conducted using R statistical software and the synthesis of results was done using forest and funnel plots. The pooled analysis showed that NPWT significantly improved ulcer healing rates (OR = 2.07, 95% CI: 1.09-3.05) and reduced time to healing (Mean Diff = -22 days, 95% CI: -41.60 to -2.40). HBOT, particularly s-HBOT, demonstrated a substantial reduction in amputation rates (OR = 0.08, 95% CI: -0.11-0.28). PRP also showed promise, especially in reducing healing time (Mean Diff = -25 days, 95% CI: -34.80 to -15.20), though with more variability across studies. The results of NPWT were found to be significantly superior for ulcer closure and reduced healing time making it the treatment of choice for DFUs. Compared to controls, both HBOT and s-HBOT were strikingly effective in averting amputations. PRP had the possibility of being used as supplementary treatment especially in treatment with regard to the aspect of promotion of healing. Collectively, these results suggest that it is possible to use such advanced therapies to enhance the treatment of DFU; however, more effort is required to refine the protocols of such therapies and determine the sources of a differential response.

Background: Diabetic foot ulcers (DFUs) are major public health problem, especially in developing countries. Still now management of diabetic foot ulcer is the major challenge for surgeons.Methods: A prospective study was done at Kamineni Institute of Medical Sciences, Narketpally; from February 2014 to January 2017. All the collected data was analyzed by the SPSS 20.0 software.Results: A total of 350 DFUs patients was included in this study. Among all of them 77.14% were male and 22.86% were female. Most common age group with DFUs was 40-60 years. All the patients had type 2 diabetes mellitus. The majority of patients were presented foot ulcers between 4 weeks to 32 weeks. 18% patients had previous history of DFUs and 11.14% had previous amputation. The forefoot was commonly affected in 48.3% of cases. Neuropathic ulcers were the most common type of DFUs in 50.6% of cases. Wagner's stage 3, 4 and 5 ulcers were the most common at 20.86%, 28% and 22% respectively. 52.86% patients were treated surgically. Lower limb amputation was the most common surgical procedure performed in 60% of cases. The complication rate was (49.7%) and surgical site infection was the most common complication (34.8%). 60% of cultures had polymicrobial growth and Staphylococcus aureus (53.3%) was the most common microorganism isolated. Most of the microorganisms isolated showed multi drug resistance to commonly used antibiotics except for Carbapenems group drugs (sensitivity 100%). The hospital stay was ranged between 15-116 days. Mortality rate was 9.4%.Conclusions: Diabetic foot ulcer is the major cause of morbidity and mortality among patients with diabetes mellitus. A proper education on foot care and appropriate foot ware, good sugar level control and early surgical intervention is needed to decrease the morbidity and mortality among diabetic foot ulcer patients.

Background: The goal of our work-study was to detect the net result and potency of of PRP local jnj. Dressings compared to PRP in jel to the wound for DFU healing compared to a control therapy of traditional classic dressing (PRP) also to decrease the recurrence (DFUs). Diabetic foot is a more famous and face any surgeon in his clinic or hospital. It has a new promise therapy of diabetic foot ulceration (DFU), with cellular and tissue regeneration, because of several methods in wound care management. All hope to attain good healing and hope to decrease recurrent rate. Patients and Methods: Forty-five patients with DFU were matched and grouped for (PRP) local injection dressings (n = 15), PRP jel to wound edges (n = 15), or classic dressing (n = 15) from August 2019 to March 2021. There were additional complications and ulcer recurrences were detected Ulcer or raw area healing and reduction were the primary objectives at 1; 3, 6, and 12 months. The study comprised 36 (80.0%) males and 9 (20.0%) females between the ages of 30 and 65 who had DFU for 1 to 10 years. Results: Local PRP injections improved healing 12/15 (80%) greater than local PRP jel dressings 10/15 (66.7%) and classic dressings 7/15(46.7%). However, PRP wound injection increase the healing of diabetic ulcers raw area more than PRP local jel or traditional classic dressing the healing period following local PRP injection was much shorter. At all follow-up visits, the in all the groups had similar rates of recurrence and complications. All of them had similar recurrence and variant safety. Conclusions: PRP injection is a more potent technique for treating DFU than local PRP jel administration and classic wound dressings, with slight the same recurrence. Less Amputation rates, infection rates, and discharges are all reduced with PRP injection than PRP jel than classic treatment.

Background Diabetic foot ulcers (DFU) are a leading cause of diabetes-related hospitalisation and can be costly to manage without access to appropriate expert care. Within Queensland and indeed across many parts of Australia, there is an inequality in accessing specialist services for individuals with DFU. Recent National Health and Medical Research Council (NHMRC) diabetic foot guidelines recommend remote expert consultation with digital imaging should be made available to people with DFU to improve their clinical outcomes. Telemedicine appears to show promise in improving access to diabetic foot specialist services; however diabetic foot telemedicine models to date have relied upon videoconferencing, store and forward technology and/or customised appliances to obtain digital imagery which all require either expensive infrastructure or a timed reply to the request for advice. Whilst mobile phone advice services have been used with success in general diabetes management and telehealth services have improved diabetic foot outcomes, the rapid emergence in the use of mobile phones has established a need to review the role that various forms of telemedicine play in the management of DFU. The aim of this paper is to review traditional telemedicine modalities that have been used in the management of DFU and to compare that to new and innovative technology that are emerging. Process Studies investigating the management of DFU using various forms of telemedicine interventions will be included in this review. They include the use of videoconferencing technology, hand held digital still photography purpose built imaging devices and mobile phone imagery. Electronic databases (Pubmed, Medline and CINAHL) will be searched using broad MeSH terms and keywords that cover the intended area of interest. Findings It is anticipated that the results of this narrative review will provide delegates of the 2015 Australasian Podiatry Conference an insight into the types of emerging innovative diagnostic telemedicine technologies in the management of DFU against the backdrop of traditional and evidence based modalities. It is anticipated that the findings will drive further research in the area of mobile phone imagery and innovation in the management of DFU.