Autologous platelet rich plasma in the management of non-healing vasculitic ulcers

Abstract

Aim: To determine the role and efficacy of platelet rich plasma (PRP) in the healing of recalcitrant vasculitic ulcers and to study the rapidity of ulcer healing with respect to platelet concentration in the prepared PRP.

Methods: This is a pilot study which included 20 patients with biopsy-proven vasculitic ulcers after excluding human immunodeficiency virus, uncontrolled diabetes mellitus, hypertension, obesity, active smoking and platelet abnormalities in peripheral smear. PRP was prepared from whole blood by centrifugation and activated using 10% calcium chloride. Activated PRP was applied over the ulcer by spraying using a syringe. Weekly dressing was done until the ulcer healed and healing was monitored using the Leg Ulcer Measurement Tool (LUMT).

Results: The total number of patients were 20 (male four; female 16). The mean age was 34.5 ± 15.36 years (2.0 SD). Mean duration of illness was 8.6 ± 2.9 months(2.0 SD). Ulcers were located in the lower third of the leg (n = 13), ankle (n = 4) and foot (n = 3) in the descending order of frequency. On average, epithelization of the wound occurred at 4.4 weeks. Faster healing was seen in mixed connective tissue disease (average 3.5 weeks) and delayed healing in systemic lupus erythematosus (average 4.7 weeks). Average platelet count obtained in the PRP was 5.52 lakhs/mm³ to 18.6 lakhs/mm³ with an increase in platelet count of 3.4- to 6-fold, respectively. Duration of healing corresponded with the platelet concentration in the prepared PRP. All the 20 patients showed complete healing within 6 weeks.

Conclusion: PRP is a safe, effective, outpatient procedure for the treatment of chronic recalcitrant vasculitic ulcers which improves the quality of life of patients and reduces their financial burden.

Keywords: Leg Ulcer Measurement Tool; growth factors; platelet rich plasma; vasculitic ulcer.