Treatment Of Chronic Nonhealing Ulcers Research Articles

Study of Efficacy of Autologous Platelet Rich Fibrin in Chronic Non-Healing Ulcers of Leg

Introduction: Platelet-rich fibrin (PRF) is the newer treatment option for treatment of chronic non-healing ulcers of leg and it contains various growth factors which boosts the wound healing. Objectives: To detect the efficacy of autologous PRF dressing in chronic non-healing leg ulcers and to assess the reduction in ulcer area at the end of each week. Materials and Methods: 30 patients (17 females, 13 males) were taken in this prospective study with informed consent. PRF was prepared by drawing 10cc venous blood and directly centrifuging it at 3000rpm (approximately 400g) for 10 minutes without adding anticoagulant. Three fractions were formed consisting of red coloured lower fraction containing RBCs, middle fraction containing PRF and upper fraction consisting of upper straw coloured platelet poor plasma (PPP). PPP fraction was discarded; middle PRF fraction was collected by separating it from the lower RBC fraction with forceps and scissors. PRF was then applied over the healthy bed of chronic non-healing ulcers every week till the wound heals. Reduction in ulcer at the end of each week is assessed by calculating area (Length×Width×0.7854). Results: The mean size of the ulcers was 10.4 cm2 initially; mean duration of ulcer was 4.7months. Complete healing required minimum 3 and the maximum 8 sittings (mean 4) no adverse events seen. Conclusion: We conclude that PRF dressing can be used as it is effective, safe, outpatient procedure in chronic non-healing leg ulcers.

A clinical study on efficacy of peri-lesional autologous platelet-rich plasma in non-healing ulcers

Background: Non-healing ulcers are a major health problem worldwide and have a great impact at personal, professional, and social levels. They are a major cause of non-traumatic lower limb amputations. The application of autologous Platelet Rich Plasma (PRP) has been a breakthrough in the treatment of non-healing ulcers, as it is an easy and cost-effective procedure, and provides the necessary growth factors that enhance tissue healing. The aim and objective of the study was to test the effectiveness of peri-ulcer autologous platelet-rich plasma injection in chronic non-healing ulcers and to assess the time taken for wound closure.Methods: This study was conducted on 50 patients during the period of November 2020 to October 2021 from the in-patients of the surgical unit in Dr. PSIMS and RF. Autologous PRP was prepared from whole blood utilizing a rapid, point-of-care system that works on the principle of density gradient centrifugation. Fifty (50) patients with non-healing ulcers of different etiologies, who met the inclusion criteria, were treated with peri-ulcer autologous PRP injections once weekly.Results: Of the 50 cases 29 were male and 21 were female, the mean age of the patients is 54.48±10.79 years. All the patients showed signs of wound healing with a reduction in wound size, and the mean time duration of ulcer healing was 6.75±1.47 weeks.Conclusions: This prospective study has demonstrated the potential safety and efficacy of autologous platelet-rich plasma injection for the treatment of chronic non-healing ulcers.

To Compare the Efficacy and Safety of Autologous Non-cultured Non-trypsinized Keratinocyte and Melanocyte Grafting (Jodhpur Technique) with Autologous Platelet-Rich Fibrin Matrix (PRFM) in the Treatment of Chronic Non-healing Ulcer.

Background:Chronic non-healing ulcers (NHUs) are often associated with some underlying pathology which prevents timely healing thus increasing the patients morbidity and healthcare expenses. Autologous non-cultured non-trypsinized keratinocyte and melanocyte grafting also known as Jodhpur technique (JT), an epidermal graft and autologous platelet-rich fibrin matrix (PRFM) are newer modalities with promising results.Aims:To compare the efficacy and safety of JT and autologous PRFM in the treatment of chronic NHU. Design: A prospective hospital based interventional study conducted on 50 patients of chronic NHU attending the dermatology outdoor of a tertiary level government hospital.Materials and Methods:After taking clearance from the institutional ethical committee, the patients were enrolled into 2 groups of 25 each. JT was done on group A and autologous PRFM on group B and their efficacy and safety compared.Statistical Analysis:Chi square test was used to analyze categorical variables summarized as number and percentage while continuous variables were analyzed using student t-test for intergroup comparison.Results:In Group A, the mean time to ulcer healing was 6.17 ± 2.17 weeks while 6.43 ± 2.33 weeks in Group B. No side effects were found in either group.Conclusion:Both the techniques fair equally in terms of wound healing time and safety but required multiple sittings in group B and a single session in group A.

A study to compare the effect of topical phenytoin dressing and conventional saline dressing in chronic non-healing ulcers

Background: Chronic non-healing ulcers; particularly diabetic and venous ulcers impose a major healthcare burden and affect quality of living. Efficacy of conventional strategies used for treatment of chronic non-healing ulcers is limited due to factors like microbial infection, necrotic tissues, tissue hypoxia, and other prevailing co-morbidities. The aim of the study was to compare efficiency of topical phenytoin-based dressings to conventional saline-based dressings for treatment of chronic non-healing wound ulcers.Methods: A prospective observational study was conducted on 60 patients who were divided in two groups. First group received conventional saline dressing-based treatment and second received topical phenytoin dressing based treatment for chronic non-healing ulcers. Efficiency of the treatment strategy was determined by statistically comparing parameters like duration of hospital stay, nature of discharge, appearance of healthy granulation tissue, and pus culture evaluation upon admission and post one and two weeks of treatment.Results: Diabetes and trauma were observed to be two major causes of chronic non-healing ulcers. No cases of venous impairment and osteomyelitis were observed in participating patients. Topical phenytoin dressing based treatment significantly reduced the duration of hospital stay and number of patients with serous discharge and aided in rapid formation of healthy granulation tissue in comparison to conventional saline based dressings. Topical phenytoin dressings also prevented microbial infection and colonization on chronic non-healing ulcers.Conclusions: Topical phenytoin-based dressing was concluded to efficiently and rapidly heal chronic ulcers while preventing microbial infection in comparison to conventional saline-based dressings.

A case series of platelet rich plasma in chronic venous ulcers.

IntroductionVenous ulcers are the most common type of leg wounds (80%) and the main cause is chronic venous insufficiency. Autologous platelet-rich plasma (PRP) is a potential wound healing treatment due to its great variety of growth factors. The aim of this study was to describe in a case series the results of poor-leukocyte PRP (P-PRP) or saline for the treatment of chronic non-healing ulcers of the lower extremity.MethodsEight patients were treated according to the topical therapy: saline solution or P-PRP gel. All patients used double compression stocks and were assisted by a vascular practitioner for up to 12 months or until wound healing. The treatment was performed weekly with cleaning of the affected area, macroscopic evaluation (area measurement and photos) and P-PRP or saline application, and closure with Tegaderm®. Trial Registration: Retrospectively approved by Brazilian Clinical Trials, register number RBR-7zhgb3 (http://www.ensaiosclinicos.gov.br/rg/RBR-7zhgb3/).ResultsAll patients showed signs of wound healing with a reduction in wound size and ulcer numbers, but more evident with P-PRP application.ConclusionsThe results suggested that P-PRP presented a better result when compared to saline solution in the healing process of long clinical course chronic venous ulcers, when associated to compressive stocks and topical care.

Treatment of leprosy wounds with “Jinchuang ointment”, a traditional Chinese herbal medicine complex

Non-healing ulcers are frequently seen in leprosy, which become one of the major causes of disability. For more than a decade, Jinchuang ointment, a traditional Chinese herbal medicine has been successfully used to treat non-healing wounds and pressure sores of diabetics in several hospitals in Taiwan. The recipe of this herbal medicine was first published in 1732. The object of this study is to evaluate the efficacy of this herbal medicine for the treatment of chronic non-healing ulcers of leprosy patients, present for up to ten years. They were already given up by other physicians to treat their wounds. Four patients with an average age of 86 were treated in this study. Our results show that Jinchuang ointment provides a feasible, safe, simple and low-cost method to treat leprosy ulcers. Due to its low cost, this traditional Chinese medicine might play an important role in treating leprosy ulcers in low income countries in the future.

118 - Treatment of chronic non-healing ulcers with adipose tissue-derived mesenchymal stem cells-a pilot study

118 - Treatment of chronic non-healing ulcers with adipose tissue-derived mesenchymal stem cells-a pilot study

Fresh hypothermically stored amniotic allograft in the treatment of chronic nonhealing ulcers: a prospective case series

Fresh hypothermically stored amniotic allograft in the treatment of chronic nonhealing ulcers: a prospective case series

Efficacy of Homologous, Platelet-rich Plasma Dressing in Chronic Non-healing Ulcers: An Observational Study.

BackgroundChronic non-healing ulcers are a frequent problem in developing countries and represent a heavy burden to the patients because they lack the necessary growth factors (GFs) to maintain the healing process and are frequently complicated by super, added infections. Traditional therapies, such as regular dressings and wound debridement, cannot provide satisfactory results since these treatments are not able to provide the necessary GFs. Platelet-rich plasma (PRP) helps in enhancing the wound healing by releasing various GFs. The aim was to evaluate the efficacy of PRP dressing in the treatment of chronic non-healing ulcers.MethodsPatients attending the outpatient department on a regular basis and those admitted as inpatients for chronic wound management were included in the study. It was an observational study done in a tertiary health center for a period of one year. All patients with eligible criteria were treated with PRP at twice-weekly intervals for a maximum of 10 dressings. At the end of the five weeks period, the reduction in the size of the ulcers (area and volume) was assessed.ResultsA total of 104 cases with chronic non-healing ulcers of various causes were treated with homologous PRP twice weekly for a maximum of 10 dressings. In those 104 patients, non-healing ulcers in 85 patients (81.73%) were healed at the end of the last dressing. Non-healing ulcers in 13 patients (12.5%) were healed with skin grafting. Among those patients, the baseline mean ulcer area was 5.03 cm2. For each visit, there was a reduction in the ulcer area. At the end of the last visit, the mean ulcer area was 1.69 cm2, which was significant in this study.ConclusionDue to the lack of necessary GFs in chronic non-healing ulcers, PRP is safe and enhances the healing rates of chronic wounds, thereby reducing overall hospital stay and morbidity.

Effect of a twin-herb formula for the Treatment of Chronic Non-healing Ulcers: a Clinical Study

Forty-four patients (27 males and 17 females) with Chronic Non-healing Ulcers that had been refractory to conventional treatment were enrolled in a single arm pre- and post-treatment clinical trial.

Treatment of chronic non-healing ulcers using autologous platelet rich plasma: a case series

BackgroundNon-healing ulcers are a major health problem worldwide and have great impact at personal, professional and social levels, with high cost in terms of human and material resources. Recalcitrant non-healing ulcers are inevitable and detrimental to the lower limb and are a major cause of non-traumatic lower limb amputations. Application of autologous Platelet Rich Plasma (PRP) has been a major breakthrough for the treatment of non-healing and diabetic foot ulcers, as it is an easy and cost-effective method, and provides the necessary growth factors that enhance tissue healing. PRP is a conglomeration of thrombocytes, cytokines and various growth factors which are secreted by α-granules of platelets that augment the rate of natural healing process with decrease in time. The purpose of this case series was to evaluate the safety and efficacy of autologous platelet rich plasma for the treatment of chronic non-healing ulcers on the lower extremity.MethodsAutologous PRP was prepared from whole blood utilizing a rapid, intraoperative point-of-care system that works on the principle of density gradient centrifugation. Twenty Four (24) patients with non-healing ulcers of different etiologies, who met the inclusion criteria, were treated with single dose of subcutaneous PRP injections along with topical application of PRP gel under compassionate use.ResultsThe mean age of the treated patients was 62.5 ± 13.53 years and they were followed-up for a period of 24 weeks. All the patients showed signs of wound healing with reduction in wound size, and the mean time duration to ulcer healing was 8.2 weeks. Also, an average five fold increase in the platelet concentrate was observed in the final PRP product obtained using the rapid point-of-care device, and the average platelet dose administered to the patients was 70.10 × 108.ConclusionThis case series has demonstrated the potential safety and efficacy of autologous platelet rich plasma for the treatment of chronic non-healing ulcers.Trial registrationNCT03026855, Registered 4 January 2017 ‘Retrospectively’

Simplified noncultured autologous cell grafting for the treatment of chronic nonhealing ulcers: the six-well plate technique

Chronic recalcitrant ulcers are associated with severe morbidity, and there are few effective treatment options available. Living skin substitutes are an important form of adjuvant therapy to enhance healing of such wounds. We investigated a novel, simplified, noncultured, autologous, cell grafting procedure, using a six-well plate technique, to treat chronic recalcitrant wounds. This was a prospective pilot study that involved harvesting an ultrathin split-skin graft from the gluteal region, which was washed, separated and prepared in six different wells to obtain an autologous mixture of keratinocytes, melanocytes and fibroblasts; this was subsequently applied directly to the wound using a hyaluronic acid (HA) matrix. Eight patients with a total of 14 ulcers were recruited. The primary endpoint assessed was the percentage of re-epithelialization of the ulcers. Secondary endpoints included quality of life and wound bed indices. At baseline, the median wound surface area was 7.4 cm(2) (mean 17.6 ± 23.6 cm(2) , range 0.5-80.0 cm(2) ) with a median duration of 18 months (mean 70.2 ± 95.9, range 3-216 months). The median wound surface area was reduced by 74.3%, from 7.4-1.9 cm(2) , at the final visit. Overall, 28.3% of the ulcers achieved complete healing, and 71.3% of the ulcers had reduction in wound size. Post-graft, there was also improvement in secondary wound bed parameters and all quality of life domains of the Cardiff Wound Impact Schedule. These results suggest that this noncultured autologous six-well technique might be beneficial for treating recalcitrant ulcers.

Efficacy of autologous platelet-rich plasma in the treatment of chronic nonhealing leg ulcers

Aim: The aim was to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of chronic nonhealing ulcers. Methods: A nonrandomized, uncontrolled study was performed on 24 patients with 33 nonhealing ulcers of various etiologies. All patients were treated with PRP at weekly intervals for a maximum of 6 treatments. At the end of the 6-week period, reduction in size of the ulcers (area and volume) was assessed. Results: The mean age of the patients was 42.5 years (standard deviation [SD] 12.48). Of 33 ulcers, there were 19 venous ulcers, 7 traumatic ulcers, 2 ulcers secondary to pyoderma gangrenosum, 2 diabetic ulcers, 2 trophic ulcers, and 1 vasculitic ulcer. The mean duration of healing of the ulcers was 5.6 weeks (SD 3.23). The mean percentage of reduction in area and volume of the ulcers was 91.7% (SD 18.4%) and 95% (SD 14%), respectively. About 100% resolution in the area was seen in 25 (76%) of the ulcers and 100% reduction in volume was seen in 24 (73%) of the ulcers at the end of the 6th treatment. Conclusion: Conventional therapies do not provide satisfactory healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors (GFs) (platelet-derived GF, epidermal GF, vascular endothelial GF, etc .) which are essential for the healing process. PRP is a safe, affordable, biocompatible, and simple office-based procedure for the treatment of nonhealing ulcers.

The Clinical Effectiveness in Wound Healing With Extracellular Matrix Derived From Porcine Urinary Bladder Matrix: A Case Series on Severe Chronic Wounds

A study involving 3 patients was performed to evaluate the efficacy of Matristem, an extracellular matrix scaffold derived from the porcine urinary bladder matrix (UBM), to promote natural healing in patients with severe, chronic wounds that did not respond well to standard wound management. In all cases, the wounds closed after only a few weeks of repeated treatments with UBM, with all patients showing complete epithelialization of the wound with limited formation of scar tissue by 13 weeks after first treatment. These initial results suggest that UBM warrants further investigation for treatment of chronic nonhealing ulcers that are recalcitrant to standard wound therapies.

Targeting Nonhealing Ulcers of Lower Extremity in Human Through Autologous Bone Marrow-Derived Mesenchymal Stem Cells

Bone marrow (BM)-derived mesenchymal stem cells (MSCs) represent a promising population for supporting new concepts in cellular therapy. This study was undertaken to assess the efficacy and feasibility of autologous BM-derived MSCs in the treatment of chronic nonhealing ulcers (diabetic foot ulcers and Buerger disease) of the lower extremities. A total of 24 patients with nonhealing ulcers of the lower limb were enrolled and randomized into implant and control groups. In the implant group, the patients received autologous cultured BM-derived MSCs along with standard wound dressing; the control group received only the standard wound dressing regimen, followed up for at least a 12-week period. Wound size, pain-free walking distance, and biochemical parameters were measured before therapy and at every 2-week interval following intervention. The implant group had significant improvement in pain-free walking distance and reduction in ulcer size as compared to those in the control group. In the implant group for Buerger disease, the ulcer area decreased from 5.04 +/- 0.70 cm(2) to 1.48 +/- 0.56 cm(2) (p < 0.001), whereas the pain-free walking distance increased from 38.33 +/- 17.68 m to 284.44 +/- 212.12 m (p < 0.001). In the diabetic foot ulcer group, the ulcer size decreased from 7.26 +/- 1.41 cm(2) to 2 +/- 0.98 cm(2) (p < 0.001) at 12 weeks. Mononuclear cells were cultured for a minimum of five passages and characterized by cell-surface markers showing CD90+, CD105+, and CD34(-). There was no significant alteration in the biochemical parameters observed during the follow-up period, indicating normal liver and renal function following intervention. Biopsy microsection of implanted tissues showed development of dermal cells (mainly fibroblasts), including mature and immature inflammatory cells. The study indicates that autologous implantation of BM-derived MSCs in nonhealing ulcers accelerates the healing process and improves clinical parameters significantly.