Results of PRP Injection, Local Jel, and Classic Dressing on Diabetic Foot Ulcer

  1. Home
  2. Articles

Results of PRP Injection, Local Jel, and Classic Dressing on Diabetic Foot Ulcer

   

Hassan A saad1, Mohamed Riad1, Ashraf Abdelmonem Elsayed1, Mohamed E Eraky1, Rashsas Elasyed1 and Ahmed k El-Taher1

 

*Corresponding author: Hassan A Saad, Zagszig University Surgical Department, Zagszig City, Egypt.

Citation: Saad HA, Riad M, Elsayed AA, Eraky ME, Elasyed RS, et al. (2023) Results of PRP injection, local jel, and classic dressing on Diabetic foot ulcer. GenesisJSurgMed. 2(1):1-10.

Received:  May 19, 2023 | Published: June 05, 2023

Copyright© 2023 genesis pub by Saad HA, et al.  CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0  International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.
 

Abstract

Background: Diabetic foot ulcers (DFU) are a prevalent clinical issue. Platelet-rich plasma (PRP) has a new promise in treating chronic ulcers for good tissue and rapid wound healing, so; wound care still debates different methods that aid wound regeneration rate. The debate of PRP still has an essential role in wound healing without complications.
Patients and methods: We have 45 cases complaining of chronic diabetic ulcer divided as follows (n = 15) local jel dressing, local PRP injections (n = 15) local PRP injection,alone (n = 15) classic dressing the study from August 2019 to March 2021.  In Zagagic University's surgical department, we follow the degree of healing at 4, 6, and 12 months. Also, detect any other complication or comorbidity, or recurrence. We have 36 (80.0%) males and female is 9 (20.0%), ages ranged from 35 and 65, who had diabetic ulceration long duration of ten years. 
Results: Injections of PRP(12/15, 80%)of healing more rapidly than local jel (10/15, 66.7%) and classic dressings (7/15, 46.7%). The healing duration in PRP injection is shorter than other methods but with the same recurrent rate.
Conclusions: PRP injection is a technique that has a more rapid healing time than local jel that injection had to mean shorter duration of wound healing than local jel, and the last (prpjel) has a shorter duration of healing than classic dressing with the same redcurrant rate or near-equal recurrence rate.

Keywords

Hassan A saad1, Mohamed Riad1, Ashraf Abdelmonem Elsayed1, Mohamed E Eraky1, Rashsas Elasyed1 and Ahmed k El-Taher1

Introduction

Loss of a part of the skin leaving large resistant ulcer in diabetic patients that resistant healing more than two years, called chronic diabetes foot ulcer of the lower leg and foot occurred mainly at the sites of pressure that prevent the patient from working and self-recovery [1]. The PRP's modes of action are, in brief, as follows: The platelets take part in the clot-forming coagulation process. Collagen from the nearby connective tissue travels immediately over the circulation after the blood vessel injury and, along with other substances, triggers the accumulation of platelets and stimulation [2]. Platelet-derived growth factors, which include (PDGF), growth factor-1, an insulin-like growth factor, growth factor-2, epidermal converting growth factor-, vascular endothelial growth factor, and fibroblast growth factors, are secreted by platelets during the creation of clots [3]. The establishment of granulomatous tissue, activation of mechanisms that result in collagen creation, a gathering of fibroblasts, macrophages, and other cells, and the emergence of new tissue are all factors that PRP has been shown to get better. Although it's a great benefit, other research must verify its action [4 PRP used in our study depends on loss or deficiency of growth factor and nutrition to the wound that ends by resistant ulcer. The comparison between local jel and local injection depends on the absorption of nutrients from wound edges being more rapid than local jel.

Many local gels or creams, or points are used for rapid wound healing either depending on bactericidal effect or aid the wound by nutrition or increasing blood supply. Still, the cost is higher and needs a prolonged duration [5]. Recombinant GF products, such as becalming (platelet-derived Growth factor recombination), give good results for ulcer healing. Autologous PRP is safer, more straightforward, and cost-effective[3]. Technique for treating foot ulcerations that may reach the muscles, tendons, and bones [6].

Patients and Methods

The study was done between August 2019 and March 2021 in Zagagic University's surgical department.  45 patients with DFU came to the outpatient clinic and were treated with vascular surgery sharing.
 
Inclusion Criteria
1. Patient with good coagulation profile for injection
2. Resistantdiabeticulcer
3. Non malignantcriteria
 
Exclusion Criteria
1. Patient with a bleeding tendency not suitable for injection
2. Malignant ulcer.
Sample Size
The 45 cases of DFU (group A n = 15), local jel (group B n = 15), PRP injection (group Cn = 15 classic dressing).
 
Study End Points
The ulcer's complete healing occurred through 6-13 months, and secondary endpoints were complications related to treatment and after concomitant good healing from 6-12 months of follow-up. After four weeks, if there is no significant healing, we stop and search for the underlying. Cause.
 
Patients Assessment
All patients resistant to healed ulcers comprehensive examination and inquiry to discover underlying risk factors to improve the outcomes and remove the risk of loss of limbs. All demographic data and patients' character, history of another disease or hypertension, ok, and BMI all data are taken into investigation, like brachial ankle index, pulse palpation, neuropathy, ulcer character, and routine investigation(lives and kidney function, CBC, fasting and postprandial blood sugar, and HBAC1A). Venous duplex, a plain X-ray, or bone CT if needed.
 
Ulcers Character
Edge, size, shape, floor, infection, and need debridement or antibiotics were all calculated with complete healing history and duration of the ulcer healing before to previous healing. Related antibiotic coverage malignant suspicious, and culture swap.
Technique 
Debridement is done for the group and before any procedures of other groups. You usually listen to words about extensive debridement needed for diabetic foot ulceration. Simply debridement is done by removing all infected tissue as possible by removing any pocket of collection, leaving a packed open wound with daily or twice daily dressing if needed. The wound character and depth of infection were observed to be suitable, with regular antiseptic diluted dressing.
 
Group B
Method of injection is essential to attain the maximum benefit of prp nutrition and Growth factor. First, don't make an injection in an infected wound as the infection interferes would healing, and the spread of infection with injection is possible to occur. Second, good wound scrape before the injection; the injection is 3-4 cm away from the edge to avoid loss if the injection locations are near. The needle was directed 45 degrees to the center of the base, then closed, dressing with wet gauze. Revision is done every three days, injection every two weeks till 6-8. Two shots are separate.
 

Preparation

They started the aspiration of about 20 ccs of blood from the visible venous source with Edita or heparin. Centrifugation of the sample 5 minutes at 3200 RPM. The aspirate, the platelet-riched upper most ⅔ was plasma; the second cycle is 5000 RPM in 10 min divided into platelet-poor plasmaand RBCs. They also aspirated the injection by 1ml syringe with needle injected as the previous description. 

Figure 1: Showing the preparation of PRP after centrifugation for local injection

Autologous PRP Jel Preparation


PRP gel is the same after blood centrifugation; the uppermost plasma riched is aspirated and mixed with added reagents. Then applied locally in a gelatinous liquid wound closed with gauze, and the patient was seen every three days.

Figure 2: diabetic foot pressure ulcer baseline

Figure 3: the ulcer size after two weeks of injection