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Sustained-Release Platelet-Rich Plasma Therapy in Grade IV Pressure Ulcers

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Platelet-rich plasma is an enriched source of growth factors and cytokines that are critical to tissue regeneration and resolution of inflammation. PRP therapy has been used successfully in orthopedic medicine for the repair of cartilaginous and ligamentous damage (Alsousou et al. 2009). People with SCI often have multiple co-morbidities that contribute to chronic inflammation and non-healing ulcers. PRP therapy has also been used for the treatment of chronic skin ulcers (Anitua et al. 2008).

Table: Platelet-Rich Plasma for Treatment of Pressure Ulcers

Discussion

Sell et al. (2011) sought to use immediate and sustained-release CaCl2-activated PRP therapy for the purpose of improving stage IV (sacral or greater trochanter) pressure ulcer healing in three veterans with SCI. Each patient underwent a different course of treatment (e.g., one patient underwent vacuum therapy and skin allograft) before healing rates stalled or plateaued. PRP therapy accelerated pressure ulcer healing in all three patients but more so in the patient whose pressure ulcer was not undermined. The two patients with severely undermined pressure ulcers did improve with respect to increased granulation and vascularity of tissue in-growth. These latter two patients’ pressure ulcers were also in more pressure sensitive locations which may have additionally contributed to slower improvement. This small case study of reactivated pressure ulcer healing in three patients is a promising indicator for a larger scale study to investigate the invigoration of healing in severe, non-healing pressure ulcers.

Although SCIRE criteria do not allow for single case studies, the single case study by De Angelis et al. (2012) increases the total sample size of patients by 33% and therefore is added here until future studies involving a larger sample size is available. In total, all four severe, non-healing ulcers reflected in these two studies showed improvement in healing as a result of PRP therapy.

Conclusion

There is level 5 evidence (from one case series and one case study; Sell et al. 2011; De Angelis et al. 2012) that supports the possibility of platelet-rich plasma therapy facilitation of reactivated healing in severe, non-healing pressure ulcers, post SCI. 

  • Additional study is required to validate platelet-rich plasma therapy as a possible treatment for severe, non-healing pressure ulcers in people with SCI.