Platelet-rich Fibrin Matrix Research Articles

Evaluation of platelet-rich fibrin matrix combined with PGE-1 injection on erectile function in patients with refractory response to PDE5-I: a randomized placebo-controlled study.

We studied the effect of a platelet-rich fibrin matrix (PRFM) combined with prostaglandin E-1 (PGE-1) injection on erectile function in patients refractory to response for phosphodiesterase type 5 inhibitors (PDE5-Is). This randomized, double-blind, placebo-controlled study included 80 patients. The patients were randomly assigned to four groups and blinded together with the administrating physicians to the nature of the intracorporeal injection (ICI) therapies. Group (1) received saline, group (2) received platelet-rich fibrin matrix (PRFM), group (3) received prostaglandin E-1 (PGE-1), and group (4) received a combination of PRFM + PGE-1. The patients received ICI therapy weekly for 8 consecutive weeks. Clinical information and follow-up data were obtained at 1, 2, 3, and 6months. A significant increase occurred in the validated Arabic version of the International Index of Erectile Function (ArIIEF-5) score in group (4) compared to the other three groups (p value = 0.037). There was a significant difference in erection hardness scale (EHS) scores among all groups after receiving the different treatments (p = 0.004). A significant increase was seen in the ArIIEF-5 score in groups 4 and 3 compared to that in groups 1 and 2 (p < 0.001). There was also a significant increase in the arterial dilatation % in groups 4 and 3 compared to that in groups 1 and 2 (p = 0.019). The combination of PRFM plus PGE-1 had shown significant improvement in the ArIIEF-5 score, yet the patients still had mild to moderate ED.

AGING MANAGEMENT WITH THE USE OF EXOSOMES, PRP/PRF WITH ALBUMIN GEL (PLASMA GEL) AND ASSOCIATED TECHNIQUES IN OROFACIAL HARMONIZATION TREATMENT

Aging, it is a physiological process that involves a progressive decline in the function of the organs, with loss of homeostasis and increased likelihood of disease disease and death. This account focuses on the classic perspectives on the biogenesis of exosomes, and age-related associated changes. Due to its ability to transmit biological information between cells, this work also discusses the interaction of mesenchymal cell exosomes, as a potent adjuvant in the treatment of association of orofacial harmonization techniques. The demand for aesthetic and rejuvenating treatments is increasing in society, thus, each day, the demand for orofacial harmonization increases exponentially in order to slow aging. Orofacial harmonization is a set of procedures performed by the dentist, which aims at the aesthetic and functional balance of the face. Exosomes are membranous extracellular vesicles ranging from 30 to 200 nm in diameter. Exosomes has been found to be secreted by most cell types, including immune cells (B cells, T cells, mastocytes, dendritic cells), neuronal cells, epithelial cells, endothelial cells, embryonic cells, cancer cells and cells mesenchymal trunk (mscs). The search for youth and perfect skin is a natural desire for the human being. And in this way, collagen biostimulation stands out as a safe and effective option to rejuvenate the skin, fighting the signs of aging and promoting a firmer, toned and radiant appearance. Research in exosomes therapies continues to prosper. Subsequent data on indications, dose response, safety, effectiveness and ability to combine therapy with exosomes as a “skin primer” for biostimulation techniques, such as calcium hydroxylapatite (CAHA), platelet rich plaketers (PRP) and fibrin matrix Platelet plasma, (PRFM) is growing rapidly.

Role of Platelet Rich Fibrin Matrix (PRFM) in Pressure Injury Management

Platelet-rich fibrin matrix, which is rich in growth factors, has been demonstrated to be beneficial in the treatment of non-healing ulcers in recent research. Aim of this study is to evaluate the role of Platelet Rich Fibrin Matrix (PRFM) in pressure injury management. In our study, after two session of Platelet Rich Fibrin Matrix (PRFM) application, the pressure sore was cover with granulation tissues.

Surgical and Biological Treatment with a Platelet-Rich Fibrin Matrix for Patellar Tendinopathy: Clinical Outcomes and Return to Sport at 2-Year Follow-Up.

Patellar tendinopathy (PT) involves anterior knee pain and functional. Platelet-rich fibrin matrix (PRFM) is a promising biological therapy for tendinopathies. We examined a cohort of PT patients treated with tendon debridement and autologous PRFM at the 24-month follow-up to assess whether the combined treatment facilitated return to sports and yielded satisfactory clinical and functional scores. Baseline and 24-month visual analogue scale (VAS), Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P), Tegner Activity Scale (TAS), and Blazina scores were compared to evaluate treatment effectiveness. The Friedman test was used to compare repeated observations of VAS, VISA-P, TAS, and Blazina Score values. Return to sport rate, Tampa Scale of Kinesiophobia (TKS) score and patient satisfaction were collected at 24 months. The postoperative clinical scores demonstrated significant improvement compared with their preoperative values (all p < 0.001). Specifically, the VISA-P score was 80.32 (±20.58), 92.10% of patients had resumed sports activities and patient satisfaction was 9.21 (±1.21) at 24 months. Surgical debridement and autologous PRFM application in patients with chronic PT resulted in a higher rate of return to sports when compared to solely surgical treatment, significantly improved clinical outcomes and excellent patient satisfaction at 24 months.

Platelet Rich Fibrin Matrix (PRFM) and Peripheral Blood Mesenchymal Stem Cells (PBMSCs) in the management of intraosseous defects - A randomized clinical trial.

A combination of peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix (PRFM) could be a probable periodontal regenerative material with the synergy of the added benefits of each material. This randomized controlled clinical trial aimed to evaluate the regenerative capacity of supercell (PRFM and PBMSCs) compared with that of PRFM alone in human periodontal mandibular intraosseous defects (IOD). This study included 17 patients of both sexes (12 men, 5 women) aged 30-55 years (mean age = 37.7±4.4 years) who fulfilled the inclusion criteria (radiographic and clinical evaluation for bilateral IOD with probing pocket depth (PPD ≥ 6 mm). A split-mouth design was used in each patient. A total of 34 sites in the mandibular arch randomly received PRFM alone + open flap debridement (OFD) [Control sites] or supercell (PRFM+PBMSCs) + OFD [Test sites]. The clinical parameters plaque index (PI), gingival index (GI), PPD, clinical attachment level (CAL), and in the radiographic parameters; defect depth (DD) and defect fill percentage (DFP) were recorded at baseline, 3 and 6 months postoperatively. Early wound healing index (EHI) was used at 1 week to assess wound healing ability. At 6 months, radiographic parameters revealed significant reduction in DD (P<0.001) and significant DFP values in the test group compared with the control group. The supercell showed significant improvement in PPD and CAL at the end of 6 months (P<0.001). EHI scores at 1 week showed no statistically significant difference between the test and control groups. Supercell can be considered a regenerative material in the treatment of periodontal IODs.

A Case Report of Periodontal Regeneration in Failing Tooth by Single Flap Approach Using Sticky Bone and Platelet-rich Fibrin Membrane

Periodontal regeneration aims to regenerate the diseased or lost periodontium. Regenerative periodontal therapy utilises growth factors, autogenous soft and hard tissue grafts for the purpose of regeneration. Platelet-rich Fibrin (PRF) is an autologous biomaterial which works on the principle of centrifugation. The injectable PRF (i-PRF) that is formed when centrifuged at low Revolutions Per Minute (RPM) produces an excellent matrix when mixed with bone graft called “sticky bone”. Sticky bone possesses the property of mouldability along with its inherent potential of bone formation. The PRF matrix also enhances the wound healing through the release of various growth factors. PRF membranes which are obtained at higher centrifugation levels also act as a substitute to augment the soft-tissues. The present case is that of a 45-year-old male, who underwent a one-year follow-up for the management of endodontic periodontal lesion in the lower left first molar with sticky bone and PRF membrane by single flap approach. The patient was periodically reviewed clinically and radiographically and prosthetic restoration was given on accessing the radiographic bone fill after six months. After six months there was a significant difference in the radiographic bone fill, along with the reduction in the probing pocket depth from 7 mm to 4 mm and clinical attachment from 9 mm to 7 mm. The results indicate that sticky bone and PRF membrane serves as a predictable source for the management of intrabony defects.

Platelet-rich Fibrin Matrix for Nonhealing Ulcers: A Case Report

Platelet-rich Fibrin Matrix for Nonhealing Ulcers: A Case Report

Effect of homologous platelet rich fibrin matrix and injectable platelet rich fibrin on full thickness skin autograft healing in dogs

Effect of homologous platelet rich fibrin matrix and injectable platelet rich fibrin on full thickness skin autograft healing in dogs

Applying additional autologous platelet-rich fibrin matrix or serial platelet-rich plasma to microfracture technique increases the quality of the repaired cartilage.

The aim of the present study is to investigate and compare the effects of biological adjuvants (platelet-rich plasma, platelet-rich fibrin matrix) and microfracture technique individually and in combination on full thickness chondral defects in a rabbit model. A total of 60 New Zealand White rabbits were randomly divided into six groups according to treatment modality as follows: control (C), microfracture (MF), platelet-rich plasma (PRP), platelet-rich fibrin matrix (PRFM), platelet-rich fibrin matrix after microfracture (MF + PRFM) and platelet-rich plasma after microfracture (MF + PRP) groups. The cartilage repair tissue was assessed histologically via International Cartilage Repair Score (ICRS) and macroscopically via ICRS macroscopic assessment scale. It was shown that overall macroscopic scores of the groups with MF were higher than those of the groups without MF. The cell morphology observed in the defect areas was mostly characterized with non-chondrocyte cells in the groups without MF, whereas chondrocyte cells mostly prevailed in the groups with MF. There was a greater integration through the cartilage-like tissue in the MF + PRP and MF + PRFM groups. The control group showed either fissures or fissures partially filled with fibrous tissue. When the groups were individually examined, there were statistically significant differences between the control and MF groups (p = 0.002), between the control and MF + PRFM groups (p = 0.001), between the control and MF + PRP groups (p < 0.001), between the PRFM and MF + PRFM groups (p = 0.014) and between the PRFM and MF + PRP (p = 0.023) groups in terms of histological evaluation scores. The application of PRP and PRFM in combination with MF treatment exhibited a positive impact on the repair and restoration of cartilage, and produced better outcomes than the individual use of PRP and PRFM. Nevertheless, in the treatment of full thickness chondral defects, the use of PRFM injection is recommended, which is performed intraoperatively at a single time and with no difficulty of repeating after surgery, instead of serial PRP injections based on the macroscopic and histological results obtained in the present study indicating that there was no significant difference between the use of these two adjuvants.

Understanding Solid-Based Platelet-Rich Fibrin Matrices in Oral and Maxillofacial Surgery: An Integrative Review of the Critical Protocol Factors and Their Influence on the Final Product.

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate whose use in clinical practice has been widely disseminated. This has led to the development of several commercial protocols, creating great confusion as to the terminology and implications of each of them. This integrative review aims to identify the critical factors of each of the phases of the solid-based PRF matrix protocol and their possible influence on their macro- and microscopic characteristics. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS, and OpenGrey was carried out. The search was temporarily restricted from 2001 to 2022. After searching, 43 studies were included that met the established criteria. There were numerous factors to consider in the PRF protocol, such as the material of the blood collection tubes, the duration of phlebotomy, the parameters related to blood centrifugation, the time from centrifugation to dehydration of the fibrin clots and their dehydration into membranes, as well as the time to clinical use. These factors influenced the macro- and microscopic characteristics of the PRF and its physical properties, so knowledge of these factors allows for the production of optimised PRF by combining the protocols and materials.

Alveolar Ridge Preservation with Autologous Platelet-Rich Fibrin (PRF): Case Reports and the Rationale.

In dental implantology, alveolar ridge preservation (ARP) has emerged as a standard technique to address dimensional changes that affect alveolar ridge morphology following tooth loss. Various alternative graft materials, including xenografts, alloplasts, and allografts, have been effectively employed in fresh extraction sites for ARP. Current evidence suggests that these materials primarily serve as bio-scaffolds, which are slowly incorporated, thus necessitating a waiting period of at least 4-6 months before implant placement. Consequently, the ARP technique extends the overall duration of implant treatment by several months. Recently, the incorporation of a form of autologous platelet concentrate, known as platelet-rich fibrin (PRF), has been advocated in conjunction with ARP as a method of bioenhancement of soft- and hard-tissue healing and regeneration. PRF contains platelet-derived growth factors, hormones, and bioactive components like cytokines that have demonstrated the ability to stimulate angiogenesis and tissue regeneration throughout all phases of wound healing. Additionally, the concentration of leukocytes present in the PRF matrix plays a vital role in tissue healing and regeneration as part of the osteoimmune response. The reported advantages of incorporating autogenous PRF platelet concentrates during ARP encompass reduced healing time, improved angiogenesis and bone regeneration, socket sealing through the fibrin matrix, antibacterial properties, and decreased post-extraction pain and infection risk. Therefore, the objective of this paper is to review the existing evidence regarding the application of PRF in alveolar ridge preservation (ARP) following tooth extraction. Two clinical case studies are presented, wherein ARP was enhanced with PRF, followed by implant placement within a relatively short period of 8 weeks. These cases serve as further proof of concept for supporting the adjuvant use of PRF to enhance healing and accelerate implant placement after ARP.

Comparative evaluation of platelet rich fibrin matrix (PRFM) membrane and collagen membrane with demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular class II furcation defects: A randomized controlled trial

Aim- The aim of the study was to compare the effectiveness of platelet rich fibrin matrix (PRFM) membrane with collagen membrane (Colo Gide) in combination with demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular Class II furcation defects. Methods- This randomized, parallel designed, controlled, clinical investigation was conducted in 24 subjects (15 male and 9 female) having Class II furcation defects either buccally or lingually. The test group was treated with DFDBA and PRFM membrane while the control group was treated with DFDBA and collagen membrane. The clinical measurements such as plaque index (PI), papillary bleeding index (PBI), pocket probing depth (PPD), relative attachment level (R-CAL) and relative gingival marginal level (R-GML) were measured at baseline and six months. Radiographic parameters, such as vertical defect depth (VDD), horizontal defect depth (HDD) and defect width (DW) were measured using cone beam computed tomography taken at baseline, three and six months. Student’s paired t-test was utilized to analyse data from the day of surgery to six months. A comparison of both groups at baseline and six months was achieved by student’s unpaired t-test. Result-10 sites in test group (83.33%) showed the advancement from class II to class I compared to eight sites in control (66.66%). Remaining defects in test group n=2 (16.66%) and control group n=4 (33.33%) showed marked reduction in horizontal defect depth compared to baseline. No complete closure of the defect was seen in either group. Conclusion- When treating class II furcation defects, the use of PRFM membrane combined with DFDBA seems to be advantages with regards to collagen membrane. The presented set up seems feasible with regards to randomization, acceptance, retention and achievement of satisfactory outcomes.

Plasma or Fibrin Matrix? A Comparative Study between PRP versus PRFM Therapy in Diabetic Foot Ulcer

Introduction: Diabetic foot ulcer is one of the most common conditions encountered in surgical OPD. The incidence of a diabetic foot ulcer is around 15% among the diabetic population. Around 80% of non-traumatic amputation is due to chronic diabetic foot ulcer. Recent advances are made in treating wounds in which platelet-rich plasma (PRP) and platelet rich fibrin matrix (PRFM) therapy have proven beneficial. Materials and Methods: A prospective study was conducted from February 2021 to February 2023, for a period of 2 years which included 42 patients. Group A received autologous platelet rich plasma therapy (PRP) and group B received autologous platelet rich fibrin matrix therapy (PRFM) each consisting of 21 patients. Results: PRFM Group showed better reduction in ulcer size compared to respective PRP Group, and demonstrated statistically significant p-values. Around 47% of the subjects had complete closure of the ulcer after 5 sessions of PRP dressing while it was 90% with PRFM dressing.

Effects of Advanced Platelet Rich Fibrin (A-PRF+), Enamel Matrix Derivative (EMD) and Open Flap Debridement on clinical and wound healing parameters in molar furcation sites: A case series from a RCT study

AimTo study effects of advanced platelet rich Fibrin (A-PRF+) and enamel matrix derivative (EMD) compared to open flap debridement (OFD) alone in molar furcation sites grade II on clinical and wound healing parameters.Materials and methodsA randomized controlled trial was designed. Eligible patients were randomly allocated in one of three treatment groups: A-PRF+, EMD or OFD. The patients and clinical examiners were blinded for the treatment received. A minimally invasive microsurgical approach was performed for the three modalities. Clinical measurements were scored at baseline and 6 months postoperatively. The clinical healing of each furcation was scored via Early Wound Healing Index on day 3, 1 week, 2 weeks and 6 weeks.Results17 patients (A-PRF+ n = 6, EMD n = 5, OFD n = 6) completed the 6 months follow-up. The further completion of the trial had to be cancelled due to the COVID-19 pandemic. In three patients in the A-PRF+ group, the grade II of the treated furcation regressed to grade I; the corresponding number in the EMD and OFD groups were zero and one respectively. Further, 3, 1 and 4 patients in the PRF, EMD and OFD groups respectively, showed a gain of bone level ≥1 mm. The defects in the A-PRF+ group showed delayed early healing compared to EMD and OFD groups.ConclusionThe case series (RCT design) suggest a slight advantage for A-PRF+ over EMD and OFD, regarding the regressing of a furcation II to grade I, however this treatment showed delayed early wound healing compared to EMD or OFD.Clinical Trial Registrationhttps://www.isrctn.com/, identifier ISRCTN13520922.

Comparative evaluation of platelet rich fibrin matrix (PRFM) membrane and platelet rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) approach technique for the treatment of multiple gingival recession in humans: A double-blind, parallel-group, randomized controlled clinical trial

Background: In this evolutionary era of dentistry, newer techniques have evolved for complete coverage of multiple recession defects (MRDs). Since 2012, MRDs have been treated using the vestibular incision subperiosteal tunnel access (VISTA) approach and a variety of regenerating membranes with varying degrees of success. Platelet‑rich fibrin matrix (PRFM) membrane has shown a robust release of growth factors and was known to enhance the healing process. Thus, in this study we have evaluated the effectiveness of platelet-rich fibrin matrix (PRFM) with that of platelet-rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) technique in Miller Class I and II multiple gingival recession defects. Methods: This randomized, parallel designed, controlled, clinical study was conducted in 20 subjects (10 male and 10 female) having class I/II MGR defects either buccally or labially. The test group was treated with VISTA and PRFM membrane while the control group was treated with VISTA and PRF membrane. The clinical measurements such as plaque index, papillary bleeding index, probing pocket depth, relative attachment level (RAL) and relative gingival marginal level (R-GML), width of keratinized gingiva (WKG), gingival recession (REC) and gingival thickness (GT) were measured at baseline, three and six months. A Student’s paired t-test was utilized to analyse data from the day of surgery to six months. Results: Ten patients in the test group (89.23±15.04) and 10 patients in the control group (85.06±17.71) showed marked root coverage compared to baseline. Conclusions: Both test and control groups showed statistically significant enhancement in root coverage. However, no statistically significant difference was found when a comparison was made between the two groups in terms of PD, relative RAL, R-GML and REC reduction, gain in WKG, and increase in GT. Trial registration: CTRI/2021/07/035240, registered 29 July 2021.

Role of Platelet Rich Fibrin Matrix in Management of Electric Burns

Electric burns injury is a problem which is still found now a days. The wound ranges from mild blistering to full thickness charring of tissues, when the wound goes into the healing phase there is difficulty due to the nature of the burns and the large area it involves. Any problem with the edge of the wound can be detrimental to healing and may cause delay in wound healing. In this article, we share our experience of using Platelet Rich Fibrin (PRF) for wound bed preparation in electric burns wound healing.

Return to Sports and Functional Outcomes after Autologous Platelet-Rich Fibrin Matrix (PRFM) and Debridement in Midportion Achilles Tendinopathy: A Case Series with 24-Month Follow-Up

(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a cohort of patients managed by tendon debridement and autologous PRFM application to determine whether the combined treatment ensured an early return to sports/work and satisfactory clinical outcomes and functional scores. (2) Methods: The 24-month outcomes of 32 sport-practicing patients with chronic midportion AT treated with debridement and autologous PRFM were evaluated in terms of time to return to sports/work. The AOFAS and VISA-A were computed preoperatively and at 6 and 24 months. Blazina scores were evaluated preoperatively and at 6 months; ankle range of motion was assessed at 1, 6, 12, 24 months; and patient satisfaction was assessed at 24 months. (3) Results: Altogether, all patients had resumed their sport(s) activity, at the same or higher level, after 25.41 days (±5.37). Regarding work, all patients were able to return to their jobs after 16.41 days (±2.43). Ankle dorsiflexion and plantarflexion increased significantly: the AOFAS rose from 54.56 (±6.47) to 97.06 (±4.06) and 98.88 (±2.21) at 6 and 12 months, respectively, and the mean VISA-A score rose from 69.16 (±7.35) preoperatively to 95.03 (±4.67) and 97.28 (±2.43) at 6 and 12 months, respectively, after treatment. There were no complications. Most (90.62%) patients were very satisfied. (4) Conclusions: In symptomatic midportion AT, surgical debridement and autologous PRFM ensured a fast return to sports/work (4 weeks), significantly improving AOFAS and VISA-A and Blazina scores already at 6 months and providing excellent clinical outcomes at 24 months.

A Comparative Study on Therapeutic Efficacy of Autologous Platelet-rich Plasma, Autologous Platelet-rich Fibrin Matrix, Recombinant Human Epidermal Growth Factor, and Collagen Particles in Nonhealing Leg Ulcers.

Nonhealing leg ulcers are challenging to manage and cause significant patient morbidity. To promote healing, newer techniques focus on delivering/enhancing dermal matrix components. The aim of this study was to compare the therapeutic efficacy of autologous platelet-rich plasma (PRP), autologous platelet-rich fibrin matrix (PRFM), recombinant human epidermal growth factor (rhEGF), and collagen particles in treating nonhealing leg ulcers. Open, randomized prospective study was conducted in a single tertiary center over 2 years where after fulfilling the criteria, randomization was done into four groups. Group A: Autologous PRP (double spin, manual method, weekly); Group B: Autologous PRFM (weekly); Group C: rhEGF (daily application); and Group D: Collagen particles (weekly) along with cleansing, debris removal, and wound dressing. Treatment endpoints were complete healing/6 months of treatment, whichever was earlier. Follow-up was done two weekly by clinical assessment, photographs, and measurement of the ulcer area. Epi info 7 software was used for statistical analysis. A total of 48 patients completed the study, 12 in each group, with mean age: 42.37 ± 4.56 years and male-to-female ratio 2.6:1. Underlying etiology was varicosities (43.75%), traumatic (25%), diabetes (22.91%), and leprosy (8.34%). At baseline, all groups were comparable in terms of patient and ulcer characteristics. Complete healing was seen in 79.17% at the end of 12 weeks: 91.67% of patients from Groups A and B each, and 66.67% from Groups C and D each. The mean time to complete healing was 6.9 ± 2.5 weeks, the least in Group B (4.73 ± 2.3 weeks). Differences between excellent (≥75%) ulcer healing across all groups were statistically significant at the end of 8 weeks where Group B showed maximum improvement. No major adverse events were seen. PRFM resulted in relatively faster ulcer healing compared with other modalities.

Combining topical dermal infused exosomes with injected calcium hydroxylapatite for enhanced tissue biostimulation.

Exosome research continues to flourish. Subsequent knowledge surrounding indications, dose-response, safety, efficacy, and the ability to combine exosome treatment as a "skin primer"-for biostimulation modalities such as calcium hydroxylapatite (CaHA), platelet-rich plasma (PRP), and platelet-rich fibrin matrix (PRFM) is growing rapidly. The objective of this study was to develop safe, reproducible methods of improving topical exosome absorption to enhance the quality of skin either by themselves, or in combination with injectable CaHA. Under IRB Approval (International Cell Surgical Society: ICSS-2022-007), 40 patients were enrolled in this study. Twenty patients underwent facial biostimulatory dermal infusion alone, to determine if this method allowed adequate exosome absorption. Five patients underwent facial biostimulatory infusion followed immediately by Dilute CaHA injection (1:1 dilution) to the face. Five patients underwent exosome biostimulatory dermal infusion followed immediately by hyperdilute CaHA (dilution 1:4) injection to the neck. Five patients underwent Facial Dilute CaHA injection (1:1 dilution) alone, without dermal infusion. Five patients underwent neck hyperdilute CaHA injection (1:4 dilution) alone, without dermal infusion. All patients had pretreatment Quantificare 3-D photo-documentation and skin analysis (Quantificare, France). In all patients, the skin was first cleansed with a gentle glycolic acid facial wash (Gregory MD). To induce a "homing inflammatory environment" for the exosomes, sea salt exfoliation was performed (SaltFacial®, SaltMed, Cardiff, CA). A nitric oxide-generating serum (N101 Pneuma Nitric Oxide, Austin, TX) was then applied to act as an enhanced vehicle for absorption. A 3MHz ultrasound (SaltFacial®, SaltMed, Cardiff, CA) was then utilized to further deepen the absorption of the nitric oxide serum. A topical emulsion containing equal volumes (1.0cc containing 1 million) of exosomes (Kimera Labs, Miramar, FL), 25 units of botulinum toxin (Xeomin, Merz Aesthetics, Raleigh, NC) and hyaluronic acid (Belatero, Merz Aesthetics, Raleigh, NC) was mixed via back-and-forth propulsion in a 3-cc syringe. When adequately mixed, the emulsion was then applied to the treatment areas. The cavitating ultrasound was then used to aid in the absorption of the emulsion. The patients were then treated with high-intensity LED therapy (SaltFacial®, SaltMed, Cardiff, CA), utilizing the collagen restoration preset program of combination red (660 nm) near-infrared (930 nm) wavelength for 20 min. Post-treatment Quantificare analysis was performed at 15 and 30 days after treatment. Without exception, all dermal infusion alone and CaHA injection alone patients showed an improvement in the tone, quality, and texture of their skin. Quantificare results showed consistent improvement in wrinkles, pores, skin evenness, improved vascularity, and a reduction in oiliness and unwanted pigment. When employed as a skin primer prior to injections (CaHA), enhanced and more rapid results were seen. Biostimulatory dermal infusion can be achieved utilizing topical placental mesenchymal stem cell-derived exosomes. These exosomes can be used alone, or mixed with ancillary ingredients such as botulinum toxin, hyaluronic acid dermal filler, and CaHA to customize and personalize treatments based upon individual patient needs. Topical absorption is enhanced with sea salt exfoliation, a topical nitric oxide-generating serum, and 3MHz cavitating ultrasound. Post-absorption activity is enhanced with high-intensity LED treatment. The addition of CaHA injections after the topical exosome "priming of the skin" yielded enhanced skin quality faster than exosomes or CaHA alone.

Platelet-Rich Fibrin–Augmented Gap-Bridging Strategy in Rabbit Anterior Cruciate Ligament Repair

Background: We assessed the efficacy of a novel platelet-rich fibrin (PRF)–augmented repair strategy for promoting biological healing of an anterior cruciate ligament (ACL) midsubstance tear in a rabbit model. The biological gap-bridging effect of a PRF scaffold alone or in combination with rabbit ligamentocytes on primary ACL healing was evaluated both in vitro and in vivo. Hypothesis: A PRF matrix can be implanted as a provisional fibrin-platelet bridging scaffold at an ACL defect to facilitate functional healing. Study Design: Controlled laboratory study. Methods: The biological effects of PRF on primary rabbit ligamentocyte proliferation, tenogenic differentiation, migration, and tendon-specific matrix production were investigated for treatment of cells with PRF-conditioned medium (PRFM). Three-dimensional (3D) lyophilized PRF (LPRF)–cell composite was fabricated by culturing ligamentocytes on an LPRF patch for 14 days. Cell-scaffold interactions were investigated under a scanning electron microscope and through histological analysis. An ACL midsubstance tear model was established in 3 rabbit groups: a ruptured ACL was treated with isolated suture repair in group A, whereas the primary repair was augmented with LPRF and LPRF-cell composite to bridge the gap between ruptured ends of ligaments in groups B and C, respectively. Outcomes—gross appearance, magnetic resonance imaging, and histological analysis—were evaluated in postoperative weeks 8 and 12. Results: PRFM promoted cultured ligamentocyte proliferation, migration, and expression of tenogenic genes (type I and III collagen and tenascin). PRF was noted to upregulate cell tenogenic differentiation in terms of matrix production. In the 3D culture, viable cells formed layers at high density on the LPRF scaffold surface, with notable cell ingrowth and abundant collagenous matrix depositions. Moreover, ACL repair tissue and less articular cartilage damage were observed in knee joints in groups B and C, implying the existence of a chondroprotective phenomenon associated with PRF-augmented treatment. Conclusion: Our PRF-augmented strategy can facilitate the formation of stable repair tissue and thus provide gap-bridging in ACL repair. Clinical Relevance: From the translational viewpoint, effective primary repair of the ACL may enable considerable advancement in therapeutic strategy for ACL injuries, particularly allowing for proprioception retention and thus improved physiological joint kinematics.