Research in Engineering and Aviation

Sustained release platelet-rich plasma as a treatment for chronic pressure ulcers: A case report

March 2011

Author(s): Sell, S.A., Ericksen, J.J., Reis, T.W., Droste, L.W., Bowlin, G.L., Bhuiyan, M.B.A., and D.R. Gater

Podium presentation at the 15th Annual International Workshop on Tissue Engineering, Hilton Head, SC, March 16-19, 2011.

Abstract

Patients suffering from spinal cord injury (SCI) are at lifelong risk of developing pressure ulcers. These wounds are typically non-healing, resulting in a downward spiral of chronic inflammation, which can be a source of morbidity and even mortality in immobile populations. Platelet-rich plasma (PRP) therapy is a method for collecting and concentrating autologous platelets for the purpose of activating and releasing their growth factor-rich alpha and dense granules. The discharge of these concentrated granules releases a number of autologous growth factors and cytokines in physiologically relevant ratios, albeit in concentrations several times higher than that of normal blood, that are critical to tissue regeneration and cellular recruitment. The use of PRP has seen a rapid increase in the realm of musculoskeletal regenerative medicine, having shown efficacy in accelerating the repair of muscle, ligament, fasciae, tendon, and bone, and may hold potential in the treatment of chronic wounds. The purpose of this report was to demonstrate the results of using alginate beads as a delivery vehicle for the sustained release of PRP derived growth factors and cytokines to stimulate healing in stalled pressure ulcers where conventional treatment methods have failed. Three SCI patients suffering from chronic stage IV pressure ulcers were treated at the bedside with PRP injections into the wound bed followed by packing of the wound with PRP:alginate beads. PRP was created with the SmartPReP® 2 (Harvest Technologies Corp.) centrifugation system, using freshly drawn venous blood (54 – 112 cc). A small volume of PRP (~10%) was activated with 10% CaCl2 (10:1 v/v) for an immediate release of growth factors, and used for injection through a 25 g needle along the ulcer margins and into the ulcer base. The remaining PRP was combined with a sterile filtered 2% alginate solution in a 2:1 ratio and added dropwise to a CaCl2 bath to create PRP:alginate beads. Beads were 2-5 mm in diameter, and were allowed to cross-link for 5 minutes to ensure formation of a solid structure before being packed into the wound. The use of PRP therapy, combining both sustained and immediate release of growth factors, stimulated healing and promoted closure in all three ulcers treated. In one large surface ulcer, rapid granulation and significant tissue in-growth occurred followed by epithelialization to the point where that ulcer would not require further in-hospital care. Two of the pressure ulcers, both with deep undermining below the surface of the ulcer opening, demonstrated a noticeable increase in wound vascularity and tissue friability followed by in-filling of the wound with new tissue and ultimate wound closure. Based upon the results of this 3 subject case report, a larger scale study is indicated to further understand the role of PRP therapy in the treatment of chronic pressure ulcers in patients with SCI.