Platelet-Rich Plasma (PRP) soaked Skin Substitute in the treatment of a Diabetic Foot Ulcer with exposed bone

Introduction: Platelet-rich plasma (PRP) is an autologous blood-derived product that contains platelet concentrations, cytokines, and platelet-related growth factors. Since the 1980s, the use of PRP to promote healing has gained attention in a multitude of medical fields, including orthopedics, cardiology, plastic surgery, and wound medicine.1,2,3 Skin substitutes (SSG) have ample research to prove efficacy in wound healing of chronic wounds.  This case study aims to illustrate the use of combination therapy with PRP soaked skin substitutes in treating a full-thickness DFU to promote wound closure.Methods:A full-thickness Diabetic Foot Ulcer (DFU) was treated with standard of care (SOC) followed by serial application of PRP soaked skin substitutes.  The wound bed was prepared with SOC treatment, including thoroughly cleaning the wound and debridement of nonviable tissue through sharp and ultrasonic debridement methods.  The PRP concentrated biologic was obtained through centrifugation of the patient's whole blood.  The skin substitute was prepared and soaked with PRP prior to placement in the wound bed. The periwound was prepped with stoma paste to wall off the graft, protect the periwound, and contain all material with a primary dressing then applied to secure the PRP soaked graft to the wound bed.  The primary dressing was perforated to allow excess drainage to escape, and a secondary dressing was then applied to allow absorption of excess drainage.  The PRP soaked graft was left in place for seven days.  Secondary dressing was changed 2-3 times weekly.  The process was repeated weekly for 12 applications.Results:Overall, wound improvement and closure was appreciated with the use of PRP in conjunction with skin substitutes.  Patient comorbidities included newly diagnosed diabetes and peripheral vascular disease, as well as hypertension.  The number of PRP soaked skin substitute applications included 12 applications total.  The time to complete wound epithelialization from wound onset to closure was 16 weeks.Discussion: PRP is a valuable advanced modality in treating chronic wounds.  This case study exhibits successful treatment of PRP in conjunction with skin substitutes for complex wounds with exposed bone.  Adequate wound bed preparation is necessary to ensure the utmost benefits of advanced modalities such as PRP and skin substitutes.  Further, ensuring repeat application and proper dressing promotes wound healing.  Current literature supports the effectiveness of PRP as an advanced modality to enhance wound healing compared to conventional therapy alone.  However, further research is needed to determine the efficacy of PRP in conjunction skin substitutes and allografts. References:1. Gonzalez dos Santos, R., Santos, G. S., Alkass, N., Chiesa, T. L., Azzini, G. O., Furtado da Fonseca, L., et al. (2021). The regenerative mechanisms of platelet-rich plasma: A review. Journal of Cytokine, 144(155560), https://doi.org/10.1016/j.cyto.2021.155560 2. Meznerics, F. A., Fehervari, P., Dembrovszky, F., Kovacs, K. D., Kemeny, L. V., Csupor, D., et al. (2022). Platelet-Rich plasma in chronic wound management: A systematic review and meta-analysis of randomized clinical trials. Journal of Clinical Medicine, 11(24), 7532. https://doi.org/10.3390/jcm11247532 3. Nazaroff, J., Oyadomari, S., Brown, N., Wang, D. (2021). Reporting in clinical studies on platelet-rick plasma therapy among all medical specialties: A systematic review of Level I and II studies. PLoS ONE, 16(4), 1-11. https://soi.org/10.1371/journal.pone.0250007 4. Armstrong, D. G., Tettelbach, W. H., Chang, T. J., De Jong, J. L., Glat, P. M., Hsu,et al. (2021). Observed impact of skin substitutes in lower extremity diabetic ulcers: Lessons from the Medicare Database (2015-2018). Journal of wound