Leucocyte- and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities

Abstract

Background: Generally, advanced wound care resources are applied for complex wounds that pose a challenge to the medical and nursing teams. In this report, the use of leukocyte- and platelet-rich fibrin (L-PRF) is emphasized for complex wounds as an alternative, simple, inexpensive, time-saving process that does not require hospitalization and has a healing potential over that of bare soft tissue, including bone, tendon, and ligaments. The aim of this study is to extend the use of L-PRF in small-to-moderate-sized complex wounds of lower extremities in which L-PRF maintains the sensitive structures viable.

Methods: Between January 2016 and December 2017, 17 small-to-moderate-sized complex wounds of lower extremities treated with L-PRF were recruited from the plastic and reconstructive surgery clinic in Aydin State Hospital, Turkey. The treatment was administered twice per week in the outpatient clinic. Depending on the size and extension of the complex wound, two to five blood samples were collected into 8.5 ml dry, glass vacuum tubes with no anticoagulant, and samples were immediately centrifuged at 1630×g for 5 min to obtain L-PRF. Complete healing was defined as the day of complete wound epithelialization.

Results: The median values of the initial wound size and wound duration were 12 cm² (interquartile range, 6 to 23 cm²) and 8 months before first admission (interquartile range, 4 to 18 months), respectively. All wounds showed significant improvements after L-PRF therapy and full closure after a median of 18 months, with an interquartile range of 11 to 34 months of L-PRF applications. There were recurrences of wounds during the first 6 months after therapy. No adverse events were observed.

Conclusions: Our results add to the growing evidence that L-PRF treatments protect and maintain bare soft tissue structures viable, facilitate the formation of granulation tissue and epithelization, and remarkably reduce the need for additional soft tissue surgeries in small-to-medium-sized complex wounds.

Keywords: Bare bone; Bare tendon; Complex wound; Leukocyte- and platelet-rich fibrin.

Fig. 1

Leukocyte- and platelet-rich fibrin is observed in the middle layer and is stripped from the adjacent red blood layer with a sterile forceps before application

Fig. 2

A 72-year-old man presented with necrosis of 80% of the total dorsal area of his foot after a soft tissue infection due to uncontrolled diabetes mellitus. a Bare tendons of the dorsal foot defect after sharp debridement due to distal flap necrosis, and b application of leukocyte- and platelet-rich fibrin (L-PRF) over the defect. c After five applications of L-PRF, a small granulation tissue started to appear with viable exposed tendons. d Six weeks after the first application, the wound contracted and the formed granulation tissue almost covered the whole bare tendon at the medial side. e Eight weeks after the first application, the wound contracted and greater than 50% of the initial wound was epithelized. f After 18 weeks of L-PRF application, a completely healed complex wound was obtained with no complications

Fig. 3

A 76-year-old-male presented with a one-and-a-half-year history of a chronic venous ulcer on his left lower leg. a The wound was initially managed with classical dressings prior to arrival at our clinic. b After six applications of leukocyte- and platelet-rich fibrin (L-PRF), c wound granulation closed over the wound. d With 24 applications of L-PRF, a good level of wound contraction was noted and the wound was nearly epithelized. e The complex chronic venous leg wound was uneventfully healed

Fig. 4

A 65-year-old-male presented with a 4-month history of a pretibial non-healed wound secondary to a trauma on his right lower leg. a Complex wound due to advanced peripheral arterial disease with diabetic dermopathy on the pretibia with an exposed bony part on the lower part after a sharp debridement. b After two applications of leukocyte- and platelet-rich fibrin (L-PRF), c wound granulation closed the bare bone. d After eight L-PRF applications, the wound was completely healed

Fig. 5

A healthy young male presented with a complex wound, including bare bone and peripherally unqualified skin and soft tissue, after tibial fracture surgeries to treat a motorbike injury. a After unsuccessful surgical operations, the patient did not prefer to undergo another surgery. b Leukocyte- and platelet-rich fibrin treatment was subsequently applied to the patient, and the wound gradually started to contract. c Approximately 6 months later, the defect was uneventfully closed

Fig. 6

A 43-year-old-male presented with a non-healing gunshot injury. a Granulation tissue of the fasciotomy area after treatment with a vacuum-assisted closure system. In this healing period, the non-healed area was observed. b Leukocyte- and platele-rich fibrin (L-PRF) application on the complex wound area of the gunshot injury. c Wound healing after six applications of L-PRF, d and wound healing after 12 applications of L-PRF. e The complex wound was uneventfully healed after 18 applications of L-PRF

Fig. 7

A 58-year-old-female presented with a peripherally erythematous left distal lower leg ulcer from an unknown cause. a The wound remained unhealed for 9 months. b Due to erythema, a topical ointment of neomycin and bacitracin was used to surround the leukocyto- and platelet-rich fibrin (L-PRF) application area. c Wound healing after two applications of L-PRF, d and wound healing after six applications of L-PRF. e The complex non-healed ulcer was successfully healed after 12 applications of L-PRF