Autologous Platelet-rich Gel Research Articles

Clinical efficacy and mechanism of the combination of autologous platelet-rich gel and recombinant human acidic fibroblast growth factor in the management of refractory diabetic foot.

This study aims to explore the influence of combining autologous platelet-rich gel (APG) with continuous vacuum-sealed drainage (CVSD) and the exogenous recombinant human acidic fibroblast growth factor (rh-aFGF) on the healing processes of diabetic foot ulcers (DFU). The primary objective is to elucidate the complex molecular mechanisms associated with DFU, providing innovative perspectives for its treatment. Ninety patients diagnosed with DFU were randomly allocated into three distinct groups. Group A underwent CVSD following wound cleansing to facilitate healing. In Group B, in addition to conventional treatment, negative pressure wound therapy was applied, and rh-aFGF was introduced into normal saline for lavage, building upon the procedures of Group A. Group C received APG along with the interventions applied in Group B. The clinical efficacy of each group was systematically observed and analyzed. Additionally, changes in plasma oxidative stress, inflammatory markers, vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor (PEDF) were assessed both before treatment and 14 days post-treatment. Following treatment, all groups exhibited commendable clinical efficacy. Group C demonstrated a superior wound healing rate, reduced frequency of dressing changes, and shorter wound healing duration (P< 0.05). Compared to baseline measurements, the levels of superoxide dismutase and PEDF increased, while malondialdehyde, VEGF, interleukin-6, interleukin-8, and monocyte chemotactic factor MCP-1 decreased in the wound tissue across all groups. Notably, Group C showed the most significant improvement in clinical efficacy and fortification of molecular mechanisms against oxidative stress (all P< 0.05). The integrative therapeutic approach combining APG with CVSD and rh-aFGF demonstrates notable efficacy in advancing wound healing. This effectiveness is evident through the reduced frequency of dressing changes and alleviation of wound-related pain. Additionally, the treatment regimen improves the cure rate for challenging, refractory wounds. These favorable outcomes can be attributed to the reduction of oxidative stress levels, attenuation of the local inflammatory response, and the enhancement of the balance between PEDF and VEGF.

Effects of continuous negative pressure suction combined with autologous platelet-rich gel on the levels of CRP, IL-6, wound healing and length of stay in clients with diabetic foot

ObjectiveContinuous passive pressure suction and APG gel therapy effect diabetic foot IL-6, CRP, wound healing, and hospitalization. MethodsClinicopathological data from 102 diabetic foot ulcer patients treated at our institution between March 2018 and May 2022 was examined. Tables generated 51 joint and controlling teams randomly. The observation team received passive pressure suction and APG gel whereas the controlled team received conventional treatment. Teams monitored therapy outcomes, adverse responses, wound healing, hospital stay, and costs. Both teams compared blood uric acid, cystatin C, homocysteine, and serum IL-6, IL-10, and CRP before and after medication. ResultsThe joint team had higher hospitalization costs, shorter stays, and faster wound healing than the controlled team. Diaparity was significant (P < 0.05). The united team worked 100 %, unlike the controlling team. This difference was significant (P < 0.05). Both teams showed significant decreases in CRP, IL-6, and IL-10 levels after therapy (P < 0.05). After therapy, both the combined and controlled teams had substantial differences in blood CRP, IL-6, and IL-10 levels (P < 0.05). Both teams had significantly decreased uric acid, cystatin C, and homocysteine after treatment. The combined team showed significantly decreased uric acid, cystatin C, homocysteine levels following therapy compared to the control team (P < 0.05). ConclusionThe joint team experienced considerably fewer adverse events (3.92 % vs. 17.65 %) than the controls team (P < 0.05). Permanent passive pressure suction and APG gel therapy lower inflammatory response, blood uric acid, cystatin C, and homocysteine, speeding wound healing, reducing side effects.

Autologous Platelet-Rich Gel Accelerates Diabetic Wound Healing Through Inhibition of Ferritinophagy.

Aims: The objective was to examine the efficacy of autologous platelet-rich gel (APG) in treating diabetic wound and investigate the association between APG and ferritinophagy. Methods: A total of 32 patients with diabetic foot (DF) and Wagner grade 1 to 2 were included. Within the APG group, individuals with DF received weekly APG treatment. In the non-APG group, DF patients received daily dressing changes. Flow cytometry quantified the proportion of endothelial progenitor cells (EPCs) in peripheral blood on days 0 and 10. The diabetic rat model was induced using Streptozotocin. Two circular skin wounds were created on the backs of rats. The normal glucose group received daily dressing changes on the wound. In the diabetic group, the left wound underwent daily dressing changes, whereas the right wound was treated with APG once a week. CD34 levels were tested 7 days after the skin damage. The levels of glutathione peroxidase 4 (GPX4), Nuclear Receptor Coactivator 4 (NCOA4), Light chain 3 (LC3), and Masson staining were quantified on 14 days. The wound area and wound healing rate were separately measured at 0 and 14 days after the injury, regardless of DF patients or diabetic rats. Results: The wound healing rate was higher in the APG group than in the non-APG group, regardless of DF patients or diabetic rats. The APG group had a greater ΔEPCs% in DF patients than the non-APG group. Regarding rat experiment, the APG group exhibited lower levels of NCOA4, and LC3 expressions and a shorter wound healing time. However, the APG group showed higher levels of CD34 expression, GPX4 protein, and collagen fibers than the non-APG group. Conclusions: Autologous platelet-rich gel accelerated the wound healing rate in diabetic populations and rats. Autologous platelet-rich gel promoted EPCs counts, collagen fiber volume, and vessel numbers. Autologous platelet-rich gel decreased LC3 and NCOA4 expression, but increased GPX4 protein expression. The possible mechanism was the inhibition of ferritinophagy.

Efficacy of Autologous Platelet-Rich Gel Combined with Negative Pressure Drainage in Patients with Diabetic Foot

Autologous platelet-rich gel (APG) has emerged as a novel treatment modality for diabetic foot, demonstrating potential in promoting wound healing and tissue repair. Negative pressure drainage has been shown to effectively remove wound exudates and facilitate wound healing. The objective of this research was to demonstrate the clinical efficacy of APG combined with negative pressure drainage in patients with diabetic foot. Following the preparation of platelet-rich plasma (PRP) gel, the influence of various temperatures and centrifugation speeds on gel properties was analyzed. PRP was assessed, and the slope and effective disaggregation rate of PRP were compared. A total of 30 healthy volunteers without diabetic foot were recruited as the control group and randomly assigned into three groups, with 10 participants in each group. The mean volume and concentration of PRP in the three groups were analyzed. A total of 30 patients with diabetic foot were selected as the observation group to analyze the therapeutic effects of APG combined with negative pressure drainage in patients with diabetic foot. The results showed that the prepared separated gel effectively isolated components in the blood, with a decrease in gel viscosity observed with increased centrifugation speed and temperature. The pH of the separated plasma remained stable. The plasma showed the best effects when immediately placed. At 0 h, 3 h, and 6 h, the PRP concentration in Group 1 was drastically superior to the other two groups (P &lt; 0.05). Regarding the slope of PRP, at 30 °C, the slope remained relatively stable; at 25 °C, the slope exhibited the largest variation. At 5 °C, the slope changed between 25 °C and 30 °C. The effective disaggregation rate was lowest when immediately placed, and it gradually increased with the prolongation of placement time. At 30, 60, 90, and 120 minutes of placement, the difference in effective disaggregation rate between 5 °C and 25 °C or 30 °C was considerable (P &lt; 0.05). The pH of PRP at 0 h, 3 h, and 6 h was weakly acidic, with inconsiderable difference in pH values among the three time periods (P &gt; 0.05). At 0 h, 3 h, and 6 h, the PRP concentration in Group 1 was markedly superior to the other two groups (P &lt; 0.05). In summary, the prepared separated gel effectively isolated PRP and the combination of APG with negative pressure drainage demonstrated remarkable therapeutic efficacy in patients with diabetic foot. The adoption of APG provides a personalized and innovative treatment option for diabetic foot patients, offering the potential to improve treatment outcomes.

Menstrual Blood–Derived Mesenchymal Stem Cells Encapsulated in Autologous Platelet-Rich Gel Facilitate Rotator Cuff Healing in a Rabbit Model of Chronic Tears

Background: Successful management of chronic rotator cuff (RC) tears remains a challenge owing to its limited intrinsic healing capacity and unsatisfactory failure rate. Menstrual blood–derived mesenchymal stem cells (MenSCs) have the potential to differentiate into the chondrogenic or osteogenic lineage. Autologous platelet-rich gel (APG), a gel material derived from platelet-rich plasma (PRP), can be applied as a carrier system for cell delivery and also as a releasing system for endogenous growth factors. Purpose: To investigate the effect of human MenSCs encapsulated in APG (MenSCs@APG) on the healing of chronic RC tears in a rabbit model. Study Design: Controlled laboratory study. Methods: After evaluation of the effect of PRP on MenSC proliferation or differentiation, the stem cells were encapsulated in APG for in vivo injection. Supraspinatus tenotomy from the right greater tuberosity was performed on 45 New Zealand White rabbits. After 6 weeks, these rabbits were randomly allocated to 3 supplemental treatments during supraspinatus repair: saline injection (control [CTL] group), APG injection (APG group), and MenSCs@APG injection (MenSCs@APG group). At week 18, these rabbits were sacrificed to harvest the humerus–supraspinatus tendon complexes for micro–computed tomography (CT), histological evaluation, tensile test, and MenSC tracking. Results: In vitro results showed that APG can stimulate MenSC proliferation and enhance chondrogenic or osteogenic differentiation. In vivo results showed that APG can act as a carrier for delivering MenSCs into the healing site, and also as a stimulator for enhancing the in vivo performance of MenSCs. Micro-CT showed that bone volume/total volume and trabecular thickness of the new bone in the MenSCs@APG group presented significantly larger values than those of the APG or CTL group (P < .05 for all). Histologically, compared with the CTL or APG group, significantly more mature fibrocartilage regenerated at the healing site in the MenSCs@APG group. A large number of human nuclei–stained cells were observed in the MenSCs@APG group, presenting a similar appearance to fibrochondrocytes or osteocytes. Biomechanically, the MenSCs@APG group showed significantly higher failure load and stiffness than the APG or CTL group (P < .05 for all). Conclusion: Human MenSCs@APG facilitated RC healing in a rabbit model of chronic tears. Clinical Relevance: Autogenous MenSCs@APG may be a new stem cell–based therapy for augmenting RC healing in the clinic.

Effect of Bismuth Subgallate/Borneol Combined with Autologous Platelet-Rich Gel in the Treatment of Patients with Diabetic Foot Ulcers

Objective: To explore the effect of Bismuth Subgallate/Borneol (SuileTM BSB) healing dressing combined with autologous platelet-rich gel (APG) in the treatment of diabetic foot ulcer (DFU). Methods: A total of 120 patients with DFU hospitalized in the Changsha Central Hospital from August 2020 to September 2021 were selected and randomly divided into an experimental group (BSB + APG, n = 60) and a control group (BSB, n = 60) according to random number table method. The total therapeutic effect, healing time, hospital stay, level indexes of various inflammatory factors before and after treatment and ulcer area were observed in the two groups. Results: The total effect of the control group was worse than that of the experimental group, and the data between the two groups were significant (P 0.05); after treatment, the levels of inflammatory factors including WBC, CRP, IL-6 and TNF-α in the control group were higher than those in the experimental group, and there was significant difference between the two groups (P 0.05); after 14 days of treatment, the ulcer area in the control group was larger than that in the experimental group, and the data between the two groups were significant (P < 0.05). Conclusion: BSB combined with APG can achieve better therapeutic effect, reduce the inflammatory reaction of patients, and promote wound healing in the treatment of patients with diabetic foot ulcer.

The Efficacy of Autologous Platelet-Rich Gel and Traditional Chinese Medicine in Diabetic Foot Treatment: A Parallel Randomized Controlled Clinical Trial

Diabetic foot (DF) is a prevalent metabolic infection. DF wounds are the basis for all cases of nontraumatic lower limb amputations in diabetes. DF care approaches include debridement of wound, pressure relief in the wounded area, proper wound, infection, and ischemia management. However, there is a need for research to develop more effective therapeutic approaches. This study investigated the effectivity and safety of autologous platelet-rich gel combined with conventional treatment and traditional Chinese medicine (TCM) in DF ulcer therapy. Sixty DF ulcer patients were divided into treatment and control groups of 30 patients each. The treatment group involved a combination of autologous platelet-rich gel, conventional treatment, and TCM. The control group was only treated with a combination of conventional therapy and TCM. Laboratory variables, including platelets, hemoglobin (Hb), albumin, and HbA1c, were analyzed and compared between the treatment and the control groups at baseline and endpoint. Healing area, volume, and rates were compared in both groups. Basic patients' data and the wound conditions had no significant difference between the treatment and the control group. The treatment and control groups cure rates were 93.3% vs. 50%, respectively. The healing rate per 2weeks was significantly higher in the treatment than in the control group (0.78±0.05 vs. 0.43±0.04). There was no statistically significant difference in the platelets, Hb, albumin, and HbA1c levels in the treatment and control groups. Autologous platelet-rich gel combined with conventional treatment and TCM is effective and safe for DF ulcer treatment.

Necrotizing fasciitis caused by diabetic foot

Necrotizing fasciitis caused by diabetic foot

Autologous Platelet-Rich Gel for the Treatment of Diabetic Sinus Tract Wounds: A Clinical Study

BackgroundThe aim of this study was to evaluate the efficacy of autologous platelet-rich gel (APG) in the treatment of deep sinus tract wounds from diabetic ulcers. MethodsForty-eight patients with diabetic ulcers were randomly classified into two groups: an APG treatment group (25 patients) and a conventional wound dressing control group (23 patients). The sinus tract closure times, ulcer healing rates, hospitalization times, and hospitalization expenses of the two groups were compared. ResultsThere were no significant differences in the basic data and wound conditions between the two groups. The cure (healed wound) rates were 96% and 87% for the APG group and control group, respectively. During the first 4 wk, the sinus tract closure rate for the APG group was significantly higher than that for the control group. However, there was no significant difference in the sinus tract healing between the two groups at the end of the 8th wk. For the APG group and the control group, the average hospital stays were 19.36 ± 7.239 d and 48.13 ± 11.721 d, respectively, and the total hospitalization expenses were 2.48 ± 0.45 ten thousand yuan and 5.63 ± 1.35 ten thousand yuan (P < 0.05), respectively. These differences were statistically significant. ConclusionsWhen compared with conventional wound dressings, APG can accelerate the healing of deep sinus tract wounds associated with diabetic ulcers.

Autologous platelet-rich gel and continuous vacuum sealing drainage for the treatment of patients with diabetic foot ulcer

Background:Research focusing on the efficacy of autologous platelet-rich gel (APRG) and continuous vacuum sealing drainage (CVSD) for diabetic foot ulcer (DFU) is increasing. Despite increasing knowledge on this theme, its results remain inconsistent. Thus, we will provide insight into the efficacy of APRG and CVSD for patients with DFU.Methods:We will search electronic databases of MEDILINE, EMBASE, Cochrane Library, CINAHL, AMED, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to October 1, 2019. No language limitation is utilized to these databases. Two authors will independently perform study selection, data extraction, and risk of bias assessment. Disagreements between 2 authors will be solved through discussion with a third author.Results:The efficacy and safety of APRG and CVSD for patients with DFU will be assessed by the time to complete healing, proportion of ulcers healed within trial period, change of size of ulcer, health-related quality of life, patient length of hospital stay, and adverse events.Conclusion:The results of this study will provide helpful evidence of APRG and CVSD for patients with DFU.Systematic review registration:PROSPERO CRD42019153289.

Lower limb arterial intervention or autologous platelet-rich gel treatment of diabetic lower extremity arterial disease patients with foot ulcers.

To investigate whether lower limb vascular intervention or autologous platelet-rich gel (APG) treatment would benefit diabetic lower extremity arterial disease (LEAD) patients with foot ulcers. A total of 82 diabetic LEAD patients with foot ulcers were recruited and divided into three groups: group A (30 patients received basal treatment), group B (21 patients received basal and APG treatment), and group C (31 patients received basal and lower limb vascular intervention treatment). All patients underwent routine follow-up visits for 6 months. The baseline characteristics and parameters were examined. After treatment, changes in all parameters from baseline were recorded. The differences between groups and the relationship among each parameter were determined. There were no differences in the ankle brachial index (ABI) or major amputation between groups A and B (P>0.05). Compared with groups A and B, the ABI and major amputation rate of group C were improved (P<0.05). There were no significant differences in transcutaneous oxygen partial pressure (TcPO2), the heal rate or minor amputation between groups A and C (P>0.05). Compared with groups A and C, TcPO2, the heal rate and minor amputation of group B were improved (P<0.05). The logistic regression analysis indicated that major amputation was mainly associated with the ABI, and minor amputation was mainly associated with TcPO2. Lower limb vascular intervention improves the ABI and reduces major amputation, and APG improves TcPO2 and reduces minor amputation. In diabetic LEAD patients with foot ulcers, major amputation was mainly associated with the ABI, while minor amputation was mainly associated with TcPO2. Interventional surgery (angioplasty) mainly improves the ABI, reduces the incidence of major amputation and improves the macrovasculature, and APG mainly improves local TcPO2, reduces the incidence of minor amputation and improves the microcirculation.

Arthroscopic knotless tape bridging with autologous platelet-rich fibrin gel augmentation: functional and structural results

ABSTRACTBackground: Rotator cuff repairs remain a source of iterative ruptures and disappointing functional results. In this goal, autologous platelet-rich plasma (PRP) has been used to improve tendon healing. This prospective study assessed the contribution of fully autologous gel concentrates (platelet concentrates and thrombin) on healing after cuff repair.Methods: A consecutive series of 69 patients who underwent primary arthroscopic knotless tape bridging primary cuff repair of supraspinatus tear were evaluated. Two groups were created (A: n = 32, B: n = 37). Autologous PRP gel, obtained preoperatively by PRP mixed with autologous thrombin extracted from platelet-poor plasma, was injected at bone-tendon interface at end of repair in group A. Gel structure avoided evacuation of concentrates with irrigation liquid. Constant, QuickDash and Visual Analogue Scale (VAS) scores were assessed pre-operatively and then successively post-operatively. Healing was assessed by 24-month control MRI according to Sugaya’s classification. Sugaya 3, 4, and 5 were considered as iterative ruptures.Results: Average age was 56 years (±7.8). Mean follow-up was similar: 28.6 months (±3.3) vs 32.4 months (±9.4). Mean preoperative Constant was similar: 53.4 (±3.4) vs 54.6 (±5.4). Group A patients received 3.5 ml (±1.5 ml) of autologous PRP gel. No specific complication of injection was found. We observed higher trend in favour of PRP without significativity: Constant 86.7 (±11.1) vs 81.6 (±14.4), p = 0.11; VAS: 0.6 (±0.3) vs 1.1 (±0.9), p = 0.13; Forward flexion: 139.5° (±14.4°) vs 137.7° (± 16.5°), p = 0.63; Strength score: 17.6 vs 14.8, p = 0.66; QuickDash: 6.2 (±5.3) vs 8.2 (±6.9), p = 0.32 . On MRI, 90% (n = 3) of repairs were healed in group A versus 86% (n = 5) in group B.Conclusion: In this preliminary study, the group treated with autologous PRP gel showed a trend towards better clinical and radiological results. These results were not significant at the last follow-up. Only significantly higher clinical results were found at 3 months.Study design: Therapeutic prospective comparative cohort study; Level of evidence III.

GDNF-ADSCs-APG embedding enhances sciatic nerve regeneration after electrical injury in a rat model.

The pluripotency of adipose-derived stem cells (ADSCs) makes them appropriate for tissue repair and wound healing. Owing to the repair properties of autologous platelet-rich gel (APG), which is based on easily accessible blood platelets, its clinical use has been increasingly recognized by physicians. The aim of this study was to investigate the effect of combined treatment with ADSCs and APG on sciatic nerve regeneration after electrical injury. To facilitate the differentiation of ADSCs, glial cell line-derived neurotrophic factor (GDNF) was overexpressed in ADSCs by lentivirus transfection. GDNF-ADSCs were mingled with APG gradient concentrations, and in vitro, cell proliferation and differentiation were examined with 5-ethynyl-2'-deoxyuridine staining and immunofluorescence. A rat model was established by exposing the sciatic nerve to an electrical current of 220 V for 3 seconds. Rat hind-limb motor function and sciatic nerve regeneration were subsequently evaluated. Rat ADSCs were characterized by high expression of CD90 and CD105, with scant expression of CD34 and CD45. We found that GDNF protein expression in ADSCs was elevated after Lenti-GDNF transfection. In GDNF-ADSCs-APG cultures, GDNF was increasingly produced while tissue growth factor-β was reduced as incubation time was increased. ADSC proliferation was augmented and neuronal nuclei (NeuN) and glial fibrillary acidic protein (GFAP) expression were upregulated in GDNF-ADSCs-APG. In addition, limb motor function and nerve axon growth were improved after GDNF-ADSCs-APG treatment. In conclusion, our study demonstrates the combined effect of ADSCs and APG in peripheral nerve regeneration and may lead to treatments that benefit patients with electrical injuries.

Efficacy of Autologous Platelet-Rich Gel for Diabetic Foot Wound Healing: A Meta-Analysis of 15 Randomized Controlled Trials.

Objectives: The meta-analysis was performed to summarize the available evidence and determine the healing effectiveness of autologous platelet-rich gel (APG) on diabetic foot (DF) wounds. Approach: PubMed and The Cochrane Library and CNKI databases were searched to identify prior randomized controlled trials. Methodological qualities of included studies were assessed using Cochrane Handbook for Systematic Reviews of Intervention. Healing rate was considered the primary outcome; the secondary outcomes included healing time and adverse events. Results: Fifteen studies involving a total of 827 subjects were analyzed in the meta-analysis. Considering the primary outcome, the average healing rate in APG group was 85.8% and ranged from 68.4% to 100%. Relatively, the control group was 57.4% and ranged from 18.2% to 75.0%. Eligible studies were compared with a fixed effects model (I 2 = 0.0%, p = 0.496), indicating a higher healing rate with APG (risk ratio [RR] 1.44, 95% confidence interval [CI]: 1.32-1.57, z = 8.50, p < 0.001). The leave-one-out sensitivity analysis is robust. Considering the secondary outcomes, APG therapy needed less time (weighted mean difference -10.75 days, 95% CI: -11.67 to 8.86 days, z = 14.34, p < 0.001) and had fewer adverse events (RR 0.44, 95% CI: 0.25-0.76, z = 2.94, p = 0.003). Innovation: APG therapy is an innovative and effective approach to promote DF wound healing and reduce healing time and adverse events. Conclusion: The meta-analysis demonstrates that APG therapy has a positive effect on the treatment of DF wounds. However, additional well-designed and high-quality studies are needed to reach a conclusion with more confidence.

Autologous platelet-rich gel treatment for diabetic chronic cutaneous ulcers: A meta-analysis of randomized controlled trials.

In recent years, many studies have reported that autologous platelet-rich gel (APG) is an effective adjuvant treatment for chronic cutaneous ulcers in diabetics. The aim of this study was to explore the efficacy and safety of APG for the topical treatment of diabetic chronic cutaneous ulcers. The China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), Chinese Wanfang database, PubMed, EMBASE, EBSCOhost, and Cochrane Library were systematically searched for relevant studies published up to 18 October 2017. Fixed- and random-effects models were used to calculate risk ratios (RR), odds ratios (ORs), and mean difference (MD) with 95% confidence intervals (95% CI). Subgroup analyses were conducted according to the Diabetic Foot Wagner Classification. Fifteen randomized control trials (RCTs) with 829 patients were eligible for inclusion in this analysis. Compared with standard care or conventional treatment, APG significantly improved the healing rate (RR 1.39; 95% CI 1.29, 1.50; P < 0.00001), shortened the healing time (MD -9.18; 95% CI -11.32, -7.05; P < 0.00001), and reduced the incidence of infection (OR 0.34; 95% CI 0.15, 0.77; P = 0.009). Current evidence suggests that APG is effective and safe, and is feasible for use as an adjuvant treatment for diabetic ulcers, especially chronic refractory ulcers. However, more RCTs with a good design and of a high quality are needed before the use of APG can be implemented widely.

Autologous platelet-rich gel for treatment of diabetic chronic refractory cutaneous ulcers: A prospective, randomized clinical trial.

The purpose of the study is to examine the safety and effectiveness of topical autologous platelet-rich gel (APG) application on facilitating the healing of diabetic chronic refractory cutaneous ulcers. The study was designed as a prospective, randomized controlled trial between January 1, 2007 and December 31, 2011. Eligible inpatients at the Diabetic Foot Care Center of West China Hospital, Sichuan University (China) were randomly prescribed with a 12-week standard treatment of ulcers (the control group) or standard treatment plus topical application APG (the APG group). The wound healing grades (primary endpoint), time to complete healing, and healing velocity within 12 weeks were monitored as short-term effectiveness measurements, while side effects were documented safety endpoints. The rates of survival and recurrence within the follow up were recorded as long-term effectiveness endpoints. Analysis on total diabetic ulcers (DUs) (n = 117) and subgroup analysis on diabetic foot ulcers (DFUs) (n = 103) were both conducted. Standard treatment plus APG treatment was statistically more effective than standard treatment (p < 0.05 in both total DUs and subgroup of DFUs). The subjects defined as healing grade 1 were 50/59 (84.8%) in total DUs and 41/48 (85.4%) in DFUs in the APG group compared with 40/58 (69.0%) and 37/55 (67.3%) in the control group from intent to treat population. The Kaplan-Meier time-to-healing were significantly different between the two groups (p < 0.05 in both total DUs and subgroup of DFUs). No side effects were identified after topical APG application. The long-term survival and recurrence rates were comparative between groups (p > 0.05). This study shows that topical APG application plus standard treatment is safe and quite effective on diabetic chronic refractory cutaneous ulcers, compared with standard treatment.

Antibacterial Effect of Autologous Platelet-Rich Gel Derived from Subjects with Diabetic Dermal Ulcers In Vitro

Background. Autologous platelet-rich gel (APG) is an effective method to improve ulcer healing. However, the mechanisms are not clear. This study aimed to investigate the antibacterial effect of APG in vitro. Methods. Platelet-rich plasma (PRP), platelet-poor plasma (PPP) and APG were prepared from whole blood of sixteen diabetic patients with dermal ulcers. Antibacterial effects against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were evaluated by bacteriostasis assay of APG, PRP, and APG-APO (APG combined with apocynin), with phosphate-buffered saline (PBS) and PPP as the control group. Results. (1) Compared to the PBS and PPP, the APG and APG-APO groups showed strong antibacterial activity against Staphylococcus aureus. There was no significant difference (P > 0.05) between APG and APG-APO. (2) Compared to PBS, APG, APG-APO, and PRP showed obvious antibacterial effects against Escherichia coli and Pseudomonas aeruginosa. No significant difference (P > 0.05) was revealed among the three groups. Compared to the PPP group, they did not show antibacterial effect against Escherichia coli and Pseudomonas aeruginosa (P > 0.05). Conclusions. APG has antibacterial effect against Staphylococcus aureus mediated by platelet activation in the diabetic patients with dermal ulcer, and does not present obvious antibacterial effect against Escherichia coli or Pseudomonas aeruginosa. Combination of APG and antibiotics may have synergistic antibacterial effect.

Exploring New Strategies for Infection Treatment

Although many improvements have been made regarding the prevention of post-surgical infection during the last few decades, implant-related infections remain an important and challenging clinical problem. With the ever-increasing number of total joint arthroplasties implanted annually and the increasing emergence of antibiotic-resistant bacteria, this challenge will be even greater in the near future. Whereas most resistant bacteria can still be treated with last-resort antibiotics such as linezolid and carbapenems, more and more multiresistant species for which there is currently no available antibiotic treatment are being found. This forces us to look at antimicrobial options outside of the traditional field of antibiotics. The efficacy of various potential new strategies has already been investigated in vitro and in vivo. These strategies included the use of antiseptics, antimicrobial peptides, silver, and autologous platelet-rich gel. Most studies have investigated the efficacy of these strategies in the prevention of implant-related infections rather than the treatment of such infections. Despite the promising results of some strategies, almost none have reached the clinical application phase. The authors of the current study investigated another novel strategy against implant-related infections—the use of bacteriophages as antimicrobial agents. Although the use of bacteriophages for this particular indication is novel, the use of bacteriophages to treat infection is actually …

Preliminary study of adjuvant therapy with autologous platelet-rich gel for refractory wound

Objective To investigate the effects of autologous platelet-rich plasma in the treatment of refractory wound.Methods Fifteen cases with refactory wound ( 1 1 males and 4 females) involving six cases with diabetic ulcer,five with post-surgical ulcer wounds and four with pressure sore were enrolled into the study.The autologous platelet-rich gel was applied to the wounds after debridement and dressing change was done every week.The results of wound bacterial culture were regularly detected and the growth of granulation was observed.Skin graft or flap graft surgery was performed to close the wound when the wound condition was permitted.Results Of all,three patients had spontaneous healing after the change of dressing,four got healing after flap graft and eight attained healing after skin graft.There was no recurrence or sinus after treatment.Conclusion Autologous platelet-rich gel accelerates wound healing,improves wound condition,and raises success rate of surgical closure of the wound. Key words: Platelet-rich plasma; Skin ulcer; Wound healing

Biochemical, mechanical, and morphological properties of a completely autologous platelet-rich wound sealant

The optimal composition of fibrin sealant preparations is not known. We, therefore, sought to construct a series of sealants from autologous components and compare their functioning to Bioseal a commonly used sealant. Characteristics of the platelet-rich plasma, cryoprecipitate, and thrombin were determined and compared to commercial glue from composition, function, and microscopy aspects. The concentrations of platelets as well as fibronectin in autologous fibrin glues were significantly higher than those in commercial ones (P < 0.001). Mechanical values (maximum amplitude and clot strength) obtained from thrombelastograph assays in two groups were not significantly different (P > 0.05). A dense platelet surface and fibrin net structures could be observed in the autologous samples, whereas there were only sparse fibrin nets without cellular components in Bioseal. Characterization of autologous and Bioseal fibrin sealants and their performance do not have significant difference in biochemical and mechanical properties. The entirely autologous platelet-rich gel in the present study may get wide application in future practice after confirmation of its safety, efficiency, and economic benefits.