Autologous platelet gel in coronary artery bypass grafting: effects on surgical wound healing

Abstract

Stimulating the body's natural healing at the cellular level can be achieved through the application of growth factors located within platelets. Once combined with a mixture of calcium and thrombin, this substance, now referred to as autologous platelet gel (APG), can be applied to surgical wound sites for patients undergoing cardiac surgery. The purpose of this study was to examine the effects of APG on surgical site infection, post-operative pain, blood loss, and bruising. After 30 mL platelet-rich plasma (PRP) was processed, 10 mL PRP was distributed on the sternum after re-approximation and 7 mL PRP before skin closure. Ten milliliters PRP was used on the endoscopic leg harvest (EVH) site. The remaining 3 mL was sent to the laboratory for hematologic testing. Both the control (CTR) and treatment (TRT) groups were well matched, with the exception of ejection fraction and pre-operative platelet count, which was significantly higher in the TRT group. Average platelet count yield was 4.2 +/- 0.5 x 103/mcL, white blood count (WBC) yielded 1.9 +/- 0.7 x 103/mcL, and fibrinogen yielded 1.2 +/- 0.2 mg/dL above baseline. There were no deep or superficial sternal infections. However, one patient from each group did experience a leg infection at the EVH site, which occurred after hospital discharge. More patients in the TRT group experienced less pain on postoperative day (POD) 1 and at the post-operative office follow-up. Blood loss and bruising was less in the TRT group on POD 2; however, there was no statistical significance. The application of APG seems to confer beneficial effects on pain, blood loss, and bruising. However, further studies with a greater sample size are needed to power significant differences.

Figure 1.

Product increase over baseline using the Medtronic Magellan Autologous Platelet Separator.

Figure 2.

(A) Sternal bruising, which measured ∼3 × 15 cm in a CTR patient on POD 2. (B) Picture taken during post-operative office follow-up.

Figure 3.

(A) Pictures of EVH incision sites in the operating room of a CTR patient. (B) Bruise noted along the medial thigh on POD 2, which measured ∼15 × 4 cm. (C) POD 3. (D) Remnant of bruise at post-operative office follow-up.

Figure 4.

(A) Pictures of EVH incision sites in the operating room of a TRT patient with evidence of a bruise. Bruise measured ∼12 × 3 cm. (B) Evolving bruise on POD 2. (C) POD 3. (D) During post-operative office follow-up.