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Platelet-rich fibrin in human acute wound models

Patricia Louise Danielsen

Summary / Abstract

Background: Growth factors in autologous platelet-rich fibrin (PRF®) may promote tissue repair. The effect of PRF® on subcutaneous collagen deposition, biomechanical strength and epithelial resurfacing and differentiation was studied in acute standardized human wounds.

Methods: In 51 patients undergoing elective laparoscopic cholecystectomy two subcutaneous polytetrafluoroethylene (ePTFE) tubes and two sutured trocar wounds were randomized to PRF® treatment or to human albumin. Transforming growth factor-β1 (TGF-β1) protein levels, collagen synthesis and deposition, and fibroblast infiltration were determined in ePTFE tubes and breaking strength of trocar wounds day 10. In 20 leg ulcer patients two adjacent split-thickness skin graft donor site wounds and the surgically debrided skin-grafted recipient wound were randomized to PRF® or not. Microscopic and macroscopic healing of donor wounds and autografts were assessed days 5 and 8, and epithelial barrier also at 1, 3 and 12 months.

Results: In PRF®-treated ePTFE tubes type I procollagen mRNA was reduced by 29% (p<0.005) and hydroxyproline by 24% (p<0.05) compared with adjacent control tubes despite doubled (p<0.0001) median TGF-β1 level. Fibroblast density did not differ significantly between PRF® and control. Hydroxyproline concentration in control tubes correlated (rs=0.48) significantly (p<0.05) with control trocar wound breaking strength. PRF® did not significantly influence epithelialization of donor sites days 5 or 8 measured in keratin-immunostained tissue biopsy sections. No significant differences were observed between PRF® and control in macroscopic epithelialization or transepidermal water loss from day 8 to 1 year in donor sites or autografts. Conclusions: PRF® did not significantly stimulate subcutaneous collagen synthesis or deposition, breaking strength of incisions, or epithelial formation and maturation in standardized human wounds.