Autologous Fibrin Membrane Research Articles

Ocular surgical use of autologous platelet‐rich plasma

AbstractEye platelet‐rich plasma (E‐PRP) concentrates platelets in a small volume of plasma which contains a high concentration of important growth factors and cell adhesion molecules. These cell adhesion molecules and growth factors occupy a major role in wound healing and enhance the physiological procedure at the site of the injury or the surgery. Platelet‐rich plasma in the form obtained in ophthalmology, E‐PRP, is a reliable and effective surgical coadjuvant to promote corneal wound healing in severe corneal ulcers and corneal perforations and may be associated with other ocular surface reconstruction procedures.Actually, platelet‐rich plasma (E‐PRP) offers new surgical perspectives in many fields of medicine helping in wound healing, it represents a greater similarity to the natural healing process as a composite of multiple growth factors, is safe due to its autologous nature and has both mitogenic and chemotactic properties. E‐PRP functions as a drug delivery system and a tissue sealant.The α‐granules within these platelets liberate platelet‐derived growth factors, platelet‐derived growth factor BB (PDGF‐BB), transforming growth factor β1 (TGF‐β1), epidermal growth factor (EGF), and vascular endothelial growth factor A (VEGF‐A) which have an important anti‐inflammatory action. It has many ocular surface applications such as in dry eye, dormant corneal ulcers, and it is also used surgically as a sutured clot of autologous fibrin membrane in big neurotrophic corneal ulcers or imminent/already perforated eyes.There are new uses of E‐PRP such as the intracameral application of E‐PRP for different purposes or injection into the lacrimal glands. All of them with the aim of improving the functionality of damaged eye tissue.

The use of an autologous platelet-rich fibrin (PRF) membrane for the treatment of deep corneal ulcers in dogs

The aim of this study was to evaluate the clinical efficacy of a platelet-rich fibrin (PRF) membrane, which is considered to be a new alternative surgical method in the treatment of vision-threatening corneal ulcers in dogs. Fourteen dogs (17 eyes) of various breeds and ages with deep corneal ulcers were treated surgically with a PRF membrane transplantation. The corneal ulcer of all the patients was closed with an autologous platelet-rich fibrin membrane. In the first 10 days after the operation, it was observed that the fibrin membrane partially melted, and corneal epithelialization and granulation tissue occurred in and around the ulcer area due to the graft material. Pain was significantly relieved, and conjunctival inflammation was noticeably improved. From the 20th day after the surgery, the granulation tissue was gradually cleaned. It was determined that all the eyes had vision. The most common complications after surgery were corneal pigmentation and fibrosis of varying severity. The use of autologous fibrin membranes is a safe and effective surgical alternative for the closure and healing of corneal ulcers. Our findings show that the autologous platelet-rich fibrin membrane is useful and effective in treating canine corneal deep ulcers.

Use of platelet- and leukocyte-rich fibrin (L-PRF) as an alternative for tissue regeneration in sinus lift surgery

This study aimed to understand how fibrin rich in platelets and leukocytes acts as an alternative for tissue regeneration in surgeries for maxillary sinus elevation. This integrative review was developed in six steps, where the guiding question was formulated according to the PICo strategy. Thus, a total of 142 publications were searched and a total of 23 articles were selected for this review after applying the inclusion and exclusion criteria. Platelet- and leukocyte-rich fibrin (L-PRF) has been increasingly investigated as a potential bioactive substance for more effective bone regeneration, not only because it is considered an easily obtained autogenous material, but also due to its high concentration of fibrin, platelets and leukocytes, assisting in the process of angiogenesis, thanks to its growth factors, which contributes to bone formation when associated with grafts, as it multiplies fibroblasts and osteoblasts. Furthermore, for the surgical method, the use of L-PRF decreases the dispersion of the graft particles used, helping to condense more mineral and consequently resulting in a smaller volume introduced into the maxillary sinus, thus minimizing the time to obtain vertical bone height. However, since the preparation is properly autologous, the amount of L-PRF acquired is insufficient, causing a disadvantage in its use. In this sense, we realize the importance of L-PRF in maxillary sinus elevation surgery, as it is a simple, cheap and the most accessible technique for the production of autologous fibrin membrane or platelet concentrate.

Solid Platelet Rich Plasma in Corneal Surgery.

Solid eye platelet-rich plasma (E-PRP) concentrates platelets in a small volume of plasma which contains a high concentration of important growth factors and cell adhesion molecules. These cell adhesion molecules and growth factors occupy a major role in wound healing and enhance the physiological procedure at the site of the injury or the surgery. There are different materials used to tectonically maintain the solid clot attached at the site where treatment is necessary. Although AM may be used for this purpose, other biomaterials such a bovine pericardium or autologous fibrin membrane are at least as effective with less interdonor variations, no biological hazards, providing a better surgical alternative than the biologically so variable amniotic membrane patch. Solid platelet-rich plasma in the form obtained in ophthalmology, E-PRP, is a reliable and effective surgical coadjuvant to promote corneal wound healing in severe corneal ulcers and corneal perforations, and may be associated with other ocular surface reconstruction procedures.FundingSupported in part by a grant from the Spanish Ministry of Science and Innovation, Centro para el Desarrollo Tecnológico Industrial (CDTI), CENIT: “Customized Eye Care”, CeyeC (CEN-20091021).

Eye platelet-rich plasma in the treatment of ocular surface disorders.

Blood-derived products [autologous serum, eye platelet-rich plasma (E-PRP), plasma rich in growth factors] are successful therapies for ocular surface disorders, which compromise the integrity of the cornea surface and conjunctiva. The most noteworthy and recent research has been directed towards hemoderivatives that include platelets. PRP for ophthalmologic use (E-PRP) has achieved successful outcomes as reported in the peer-review literature in the treatment of dry eye, post-laser in-situ keratomileusis ocular surface syndrome, dormant ulcers, and for ocular surface surgical reconstruction after corneal perforation associated to amniotic membrane transplantation, bovine pericardium membrane transplantation, or autologous fibrin membrane combined with solid PRP clot. PRP is a portion of the patient's own blood having a platelet concentration above baseline. The main advantage of PRP over other products is the presence of the platelets and associated with this the prolonged release of growth factors that are involved in the wound healing process of the cornea and conjunctival surface. E-PRP seems to be a reliable and effective therapeutic approach to enhance epithelial wound healing and promote ocular surface regeneration in different pathological conditions.

Autologous Fibrin Membrane Combined With Solid Platelet-Rich Plasma in the Management of Perforated Corneal Ulcers

The combined use of autologous fibrin membrane and the eye platelet-rich plasma (E-PRP) clot could be considered as a new surgical alternative for the closure of corneal perforations. To evaluate the use of autologous solid platelet-rich plasma in combination with an autologous fibrin membrane as a surgical alternative for wound closure in perforated corneal ulcers. Both the fibrin membrane and the E-PRP clot were prepared with the patient's own blood just before the operation. Nylon stitches were used to fixate the fibrin membrane to the conjunctiva and then the E-PRP clot was placed over the corneal perforation, underneath the fibrin membrane. A temporal partial tarsorrhaphy was performed at the end of the procedure. We conducted postoperative monitoring for 3 months. SETTING Vissum Corporacion Oftalmologica, Alicante, Spain. Eleven patients with perforated corneal ulcers. Surgical alternative for the closure of corneal perforation. Corneal biomicroscopy, fluorescein test, digital tonometry. In all cases the corneal perforation was sealed. The fibrin membrane was present over the corneal surface for the first 3 to 5 days and then gradually disappeared. No evidence of infection or inflammation was detected. Digital tonometry confirmed acceptable levels of ocular tonus in all cases from day 2 after the operation. No patients reported pain, discomfort, or other symptoms, and no complications were observed. After 3 months' follow-up, there was no evidence of relapses or perforations. Corneal grafting was eventually performed in 7 of the 11 cases. The combined use of autologous fibrin membrane and E-PRP clot is a safe and effective surgical alternative for the closure of corneal perforations. This technique can be considered as a temporary measure until the condition of the cornea permits definite intervention.

Bilateral Sinus Elevation Evaluating Plasma Rich in Growth Factors Technology: A Report of Five Cases

The purpose of this study was to evaluate the potential effects of plasma rich in growth factors (PRGF) technology and its autologous formulations in five consecutive patients in which bilateral sinus lift augmentation was carried out. Five consecutive patients received bilateral sinus floor augmentation. All patients presented a residual bone height of class D (1-3 mm). The effects of PRGF combined with bovine anorganic bone (one side) were compared with the biomaterial alone (contralateral side). The effects of using liquid PRGF to maintain the bone window and autologous fibrin membrane to seal the defect were evaluated. A complete histological and histomorphometrical analysis was performed 5 months after surgery. One patient was excluded from the study as the Schneiderian membrane of the control side was perforated during the surgery. In two patients, the biopsies obtained from the control sides 5 months postsurgery were not acceptable for processing. PRGF technology facilitated the surgical approach of sinus floor elevation. The control area was more inflamed than the area treated with PRGF technology. Patients referred also to an increased sensation of pain in the control area. PRGF-treated samples had more new vital bone than controls. In patient number 1, image processing revealed 21.4% new vital bone in the PRGF area versus 8.4% in the control area, whereas in patient number 2, 28.4% new vital bone was quantified in the PRGF area compared with the 8.2% of the control side. The immunohistochemical processing of the biopsies revealed that the number of blood vessels per square millimeter of connective tissue was 116 vessels in the PRGF sample versus 7 in the control biopsy. These preliminary results suggest that from a practical point of view, PRGF may present a role in reducing tissue inflammation after surgery, increasing new bone formation and promoting the vascularization of bone tissue.

Clinical application of platelet-rich fibrin as the sole grafting material in periodontal intrabony defects

Background/purpose Platelet-rich fibrin (PRF) obtained by Choukroun’s technique is a healing biomaterial that concentrates in a single autologous fibrin membrane, mostly of platelets and cytokines from blood harvest, and without any artificial biochemical modification. However, no data are presently available concerning the use of PRF for the treatment of periodontal intrabony defects. This report was to present the clinical and radiographic changes of a patient with periodontal intrabony defects treated with PRF. Material and methods The left mandibular first molar (#36) and left maxillary second molar (#27) with intrabony defects were filled with PRF as the sole grafting material in a 38-year-old female patient. The primary outcomes evaluated in this study included changes in probing depth, attachment level, and radiographic bone density between baseline and 6 months postoperatively. Results The results showed that the application of PRF as the sole grafting material in intrabony defects exhibited pocket reduction and gain in clinical attachment after 3 months and 6 months. Using National institute of health program, the 6 months postoperative radiographic density of images for #27 and #36 showed an increase of 1.6 and 1.3 fold compared with each preoperative radiography, respectively. Conclusions From a clinical and radiologic point of view at 6 months after surgery, the use of PRF as the sole grafting material seems to be an effective modality of regenerative treatment for periodontal intrabony defects.

自己血由来フィブリン膜・フィブリンゲルの組織学的安定性に関する検討―鼓膜形成術における新素材―

The simple underlay myringoplasty has evolved, enabling it to be performed more easily and safely. However, this procedure needs fibrin glue that is made from donated blood. Furthermore, a skin incision is necessary to take the subcutaneous connective tissue graft. There are some reports regarding the methods of using a collagen sheet or chitinous substance membrane as a substitute for the subcutaneous connective tissue graft. However, no report has appeared regarding a myringoplasty using a membrane made from the patient’s own blood. The aim of this study is to establish the procedure of less invasive myringoplasty from the aspect of safety using autologous blood from the patient. We have developed a procedure to make the autologous fibrin membrane and gel. We evaluated the histological stability of the fibrin membrane and gel using image analysis equipment. The density of the fibrin fiber was measured at the time of production, after 24 hours, 48 hours, 72 hours, 1 week, and 2 weeks. Welch’s t-test was used for the statistical analysis. The fibrin membrane had less microscopic changes even at the 2-weeks assessment. There was no statistically significant difference between the density of the fibrin membrane fiber and the fascia at 2 weeks. In contrast, the fibrin gel had melted and disappeared at 1 week. It is thought that the fibrin membrane might produce a scaffold for the regeneration of the tympanic membrane as a substitue for the subcutaneous connective tissue or fascia. These results indicate that myringoplasty using the fibrin membrane could be a safer and less invasive procedure.

The Relevance of Choukroun's Platelet-Rich Fibrin and Metronidazole During Complex Maxillary Rehabilitations Using Bone Allograft. Part II: Implant Surgery, Prosthodontics, and Survival

Extensive bone grafting remains a delicate procedure, due to the slow and difficult integration of the grafted material into the physiological architecture. The recent use of platelet concentrates aims to improve this process of integration by accelerating bone and mucosal healing. Choukroun's platelet-rich fibrin (PRF) is a healing biomaterial that concentrates in a single autologous fibrin membrane, most platelets, leukocytes, and cytokines from a 10-mL blood harvest, without artificial biochemical modification (no anticoagulant, no bovine thrombin). In this second part, we describe the implant and prosthetic phases of a complex maxillary rehabilitation, after preimplant bone grafting using allograft, Choukroun's PRF membranes, and metronidazole. Twenty patients were treated using this new technique and followed up during 2.1 years (1-5 years). Finally, 184 dental implants were placed, including 54 classical screw implants (3I, Palm Beach Gardens, FL) and 130 implants with microthreaded collar (46 from AstraTech, Mölndal, Sweden; 84 from Intra-Lock, Boca Raton, FL). No implant or graft was lost in this case series, confirming the validity of this reconstructive protocol. However, the number of implants used per maxillary rehabilitation was always higher with simple screw implants than with microthreaded implants, the latter presenting a stronger initial implant stability. Finally, during complex implant rehabilitations, PRF membranes are particularly helpful for periosteum healing and maturation. The thick peri-implant gingiva is related to several healing phases on a PRF membrane layer and could explain the low marginal bone loss observed in this series. Microthreaded collar and platform-switching concept even improved this result. Multiple healing on PRF membranes seems a new opportunity to improve the final esthetic result.

The Relevance of Choukroun’s Platelet-Rich Fibrin and Metronidazole During Complex Maxillary Rehabilitations Using Bone Allograft. Part I: A New Grafting Protocol

Extensive bone grafting remains a delicate procedure, because of the slow and difficult integration of the grafted material into the physiological architecture. The recent use of platelet concentrates aims to improve this process of integration by accelerating bone and mucosal healing. Choukroun's platelet-rich fibrin (PRF) is a healing biomaterial that concentrates in a single autologous fibrin membrane, most platelets, leukocytes, and cytokines from a 10 mL blood harvest, without artificial biochemical modification (no anticoagulant, no bovine thrombin). Whether used as a membrane or as fragments, PRF allows a significant postoperative protection of the surgical site and seems to accelerate the integration and remodeling of the grafted biomaterial. These properties are particularly helpful for vestibular bone grafting on the alveolar ridges. Moreover, it provides a very high quality of gingival maturation.A small quantity of a 0.5% metronidazole solution (10 mg) can also be used to provide an efficient protection of the bone graft against unavoidable anaerobic bacterial contamination. This article describes a new technique of total maxillary preimplant bone grafting using allograft, Choukroun's PRF membranes and metronidazole. This first part focused on the preimplant reconstructive treatment using allogeneic bone granules. PRF membranes are particularly helpful to protect the surgical site and foster soft tissue healing. This fibrin biomaterial represents a new opportunity to improve both the maturation of bone grafts and the final esthetic result of the peri-implant soft tissue.