Use of Leukocyte Platelet (L-PRF) Rich Fibrin in Diabetic Foot Ulcer with Osteomyelitis (Three Clinical Cases Report).

Alessandro Crisci,Anna Licito,Giuseppe Marotta,Giulio Benincasa,Edda Serra,Michela Crisci

doi:10.3390/diseases6020030

Alessandro Crisci, Anna Licito + Show 4 more

Open Access

https://doi.org/10.3390/diseases6020030

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Abstract

In this study, the use of fibrin rich in leukocytes and platelets (L-PRF) was explored to heal osteomyelitis ulcers in a diabetic foot. The goal was to standardize the utilization of L-PRF in patients with osteomyelitis to direct it for healing. L-PRF was obtained autologously from the peripheral blood of the diabetic patients (n = 3) having osteomyelitis and skin lesions for at least six months. The L-PRF and supernatant serum were inserted into the skin lesion to the bone after a surgical debridement. The evolution of lesions over time was analyzed. All three patients showed positivity to the Probe-to-Bone test and Nuclear Magnetic Resonance detected cortico-periosteal thickening and/or outbreaks of spongy cortical osteolysis in adjacency of the ulcer. The infections were caused by Cocci Gram-positive bacteria, such as S. Aureus, S. β-hemolytic, S. Viridans and Bacilli; and Gram-negative such as Pseudomonas, Proteus, Enterobacter; and yeast, Candida. The blood count did not show any significant alterations. To date, all three patients have healed skin lesions (in a patient for about two years) with no evidence of infection. These preliminary results showed that L-PRF membranes could be a new method of therapy in such problematic diseases. Overall, the L-PRF treatment in osteomyelitis of a diabetic foot seems to be easy and cost-effective by regenerative therapy of chronic skin lesions. In addition, it will improve our understanding of wound healing.

Highlights

Osteomyelitis (OM) refers to a bone marrow infection in contrast to osteitis wherein the periosteum or cortical surface becomes infected through a penetrating wound or ulcer
If the time required to collect blood and process for centrifugation is prolonged, the fibrin polymerization becomes widespread in the tube and only a small part of the blood clot could be obtained without consistency (PRF-like)
The blood collection must be followed by immediate centrifugation, which is essential for good platelet-rich fibrin (PRF) yield

Summary

Introduction

Osteomyelitis (OM) (bone infection) refers to a bone marrow infection in contrast to osteitis wherein the periosteum or cortical surface becomes infected through a penetrating wound or ulcer. Despite these differences, both are clinically diagnosed or treated in a very similar manner. There have been many studies on the diagnosis of OM and, most importantly, on the complication of diabetic foot ulcers (DFU). OM is a comorbidity of the DFU, which almost always arises from a contiguous wound or an ulcer of the foot [1]. Bone and joint infections are frustrating and exasperating for both patients and doctors.

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