Autologous platelet gel in the management of diabetic and other recalcitrant ulcerations
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Publication: Journal of Endovascular Therapy
Start Page: E4
Diabetic foot ulceration is a common and often debilitating problem. Often treating the underlying pathology correctly and controlling the infection will result in wound healing. Occasionally, however, despite correction of the underlying pathology and the appropriate topical management, some ulcers still fail to heal. Working in an integrated wound clinic for the past 16 years, I have had the opportunity to trial and apply new technologies in the treatment of these somewhat difficult to heal ulcers. One of the newest and exciting prospects for the management of these recalcitrant ulcers has been the use of autol ogous platelet gel (APG). Platelets are rich in multiple growth factors required for wound healing. A concentrate of platelets has very high levels of these multiple growth factors. This technology has so far been reserved for the most difficult recalcitrant ulcers encountered in our practice. All ulcers had been present for at least 6 months (range 6-64). Of all these difficult ulcers treated, 48% were vasculitic in origin, 25% were diabetic, and 11% of cases had unknown etiology. Patients were treated either in our clinic or on the ward. Blood, 50 to 150 mL depending on the size of the ulcer, was extracted from the patient and placed in a small portable centrifuge. Three to 5 mL of pure concentrated platelets would normally be produced per 50 mL of blood centrifuged. Fibrin was then added to the platelet concentrate to form the gel that was then applied to the ulcers. To date, we have undertaken 81 applications in 63 diabetic patients. In approximately one third of the patients, topical negative pressure dressing was used for a significant period,,prior to the application of the gel. With this technique we have been successful in healing all but 5 ulcers. Failure occurred in 3 due to severe non-reconstructable arterial insufficiency. Two failures occurred in the presence of sepsis with MRSA and Pseudomonas. Conclusion: At the present time, while the results have been very impressive, the findings are anecdotal only. To determine the true efficacy of this treatment, a randomized prospective double blind trial is required. The implications of this and the physiology behind the use of the APG along with a comprehensive analysis of the results will be presented.