Journal_1_2014_final_WEB

Science, Practice and Education
Table 2. Treatment outcomes in the study groups (n=81; p 60
Average inpatient hospital stay, days 11.0 + 2.5 23.1 + 1.5
Average cost to treat one patient, EUR 785.25 1649.02
a PRP clot thickness of about 1-2 mm, 45-50 ml of whole
blood would be required. The volume of PRP obtained on
average is 20-25% of the original volume per individual,
depending on the rheological properties of the blood of
each patient. The time from the moment of blood collection
to wound dressing was 20-30 minutes. The PRP flat
clot was covered with an atraumatic mesh dressing and
a secondary dressing on top of the former. The dressing
frequency was once in 7 days, allowing patient transition
from inpatient to outpatient care.
Thirty-seven patients in phase II of wound-healing (the
reference group that included 17 men and 20 women with
an average age of 69.5 ± 2.2 years with VLU (5 patients),
UME (12 patients), DFS (8 patients), STU (5 patients)
or DU (7 patients), with an average wound area of 79.6
± 12.3 cm 2 ) received traditional topical therapy such as
povidone-iodine gel, Olasol spray, Actovegin gel and modern
interactive wound dressing materials.
Planimetry of the wounds of all of the patients was
performed every seventh day from the time the patient was
enrolled in the study. After discharge from the hospital, all
of the patients were followed up in an outpatient setting
with a frequency of visits of once a week.
Results
The method that we used enabled us to obtain plasma
with a platelet content of approximately 338% higher than
that of whole blood. Previously, we studied the effect of
PRP on the proliferative activity of human cells in vitro
using M-22 human fibroblast cell culture (the study was
carried out jointly with the Laboratory of Cell transplantation
and Immunotyping of the Sklifosovsky Scientific
Research Institute of Emergency Medicine), and we have
confirmed the effectiveness of this method in terms of the
PRP stimulation of regeneration processes [27-29] .
At the Purulent Surgical Department of City Clinical
Hospital no. 13, we conducted a randomised controlled
study to evaluate the efficacy of PRP use for the treatment
of chronic non-healing wounds of different aetiology.
Considering the presence of wound defects mainly in
the soft tissues, we used PRP in the form of a flat, gel-like
clot. Results were evaluated over a 3-month period.
In the study group, the average number of applications
of PRP in one patient was 6.0 ± 0.6. In three patients,
the large size of the wound defect after 3- 4 applications
made the transplant free split the skin flap over the wound;
complete epithelialisation of chronic wounds was achieved
in 35 patients (85.4%) in 46.4 ± 4.3 days. The method
was not effective in five patients (1 VLU, 1 UME, and 3
STUs); full epithelialisation was achieved in one patient
within a period of more than 90 days. In the comparison
group, skin grafting was achieved in three patients, and
epithelialisation of the wound up to 3 months was attained
in only four patients (11.8%). Treatment failure – i.e., lack
of epithelialisation of the wound within a period of 90 days
– was observed in 23 patients (62.2%) in the comparison
group: 2 VLUs, 9 UMEs, 6 DFSs and 6 STUs.
The average duration of hospitalisation was 11.0 ± 2.5
days in the study group and 23.1 ± 1.5 days in the comparison
group. Importantly, the average duration of hospital
treatment was 7.5 days in patients with a high content
of platelets with grains in the plasma (300-600,000/ml)
and 12.7 days in patients with secondary (150-290,000/
ml) and low (100-130,000/ml) content of platelets on
average – i.e., the efficiency of treatment with autologous
PRP depends on the content of the functionally suitable
platelets. The average cost of treatment for one treated
patient differed by more than two fold and amounted to
(at the rates of 2012) 785.25 Euros and 1649.02 Euros
in the experimental and control groups, respectively. The
study results are presented in Table 2.
Case report
Patient P., an 18-year-old male, presented to the outpatient
department with a postoperative ulcerated scar and trophic
ulcer in the interscapular region. In 2006, he had undergone
surgical endocorrection of scoliosis using a singleplate
endocorrector that was removed in 2011 due to the
occurrence of multiple purulent fistulas. The wound defect
was corrected by plastic repair that later resulted in scar
formation and trophic ulceration. Upon primary examination,
the wound defect had dimensions of 63 × 54 mm,
and the wound bed was filled with sluggish granulations.
No microorganisms were detected in the wound before the
initiation of treatment with PRP. The PRP applications
EWMA Journal 2014 vol 14 no 1 39