Treatment of nonhealing diabetic lower extremity ulcers with skin graft and autologous platelet gel: a case series

Abstract

Lower extremity ulcers in diabetic patients are difficult to treat. Recently, the use of human blood platelet-derived components in this indication has been raising interest. In this study, we have evaluated the safety and efficacy of the combination of autologous platelet gel (PG) and skin graft for treating large size recalcitrant ulcers. Eight consecutive diabetic patients aged 25 to 82 with nine nonhealing lower extremity ulcers (median size of 50 cm(2); range 15-150 cm(2)) were treated. Skin ulcer was debrided, and the wound was sprayed after 7 to 10 days with autologous platelet-rich plasma and thrombin. Thin split-thickness skin graft with multiple slits was then applied on the wound bed and fixed with staples or cat-gut sutures. There were no adverse reactions observed during the study. Eight out of 9 skin grafts took well. The interval between skin graft and complete wound healing ranged from 2 to 3 weeks in the 8 successful cases. No ulcer recurrence was noted in those patients during the follow-up period of 2 to 19 months. In this study, the combination of autologous platelet gel and skin grafting has proven beneficial to heal large-size recalcitrant ulcers.

Figure 1

Biosafe SEPAX system (a). Autologous PRP and plasma to prepare platelet gel and thrombin (b). Thrombin generation device to activate plasma (c). Double-syringe applicator containing PRP and thrombin (d).

Figure 2

Platelet gel formed on the wound by conversion of fibrinogen into fibrin.

Figure 3

Two chronic ulcers (15 × 10 cm² and 5 × 7 cm²) with surrounding scar tissues (a). After adequate debridement, the wound was sprayed with PRP and thrombin (b). Skin graft was applied on gel-covered wound bed (c). Durable wound coverage 10 months after skin graft (d, e).

Figure 4

Burn injury with chronic ulcer (6 × 10 cm²) (a). After adequate debridement, the wound was sprayed with PRP and thrombin (b). Skin graft was applied on gel-covered wound bed (c). Durable wound coverage 12 months after skin graft (d).

Figure 5

Chronic ulcer (10 × 15 cm²) deep to the periosteum of calcaneus bone (Arrow) (a). After adequate debridement, the wound was sprayed with PRP and thrombin (b). Skin graft was applied on gel-covered wound bed (c). Skin graft loss (3 cm²) over the periosteum, 2 months after skin graft (d).