Applications of blood plasma derivatives for cutaneous wound healing: A mini-review of clinical studies

Abstract

Skin injuries are a global healthcare problem. Chronic ulcers do not heal in a timely fashion, so it is essential to help the body with skin repair. There are some treatments that have been applied to chronic ulcers. One of these treatments is growth factor (GF) therapy. Platelet-rich plasma (PRP) and Platelet-poor plasma (PPP) are two types of plasma derivatives containing many GFs important for wound healing. Several works have reported their application in wound healing and tissue regeneration. The use of autologous PRP is now an adequate alternative in regenerative medicine. It was also demonstrated that PPP is a hemostatic agent for wounds. This review has studied the latest clinical studies, which have applied PRP and PPP to patients with chronic wounds.

Keywords: Chronic wounds; Clinical study; Platelet-poorplasma; Platelet-rich plasma; Skin.

Fig. 1

Human skin structure and its appendix. Skin layers include Epidermis, Dermis, Hypodermis, and other appendices (i.e., nerves, veins, glands, cell population, etc.).

Fig. 2

Wound healing in acute and chronic wounds, In acute wounds, after the formation of crust, the hyperproliferative epidermis grows and moves forward on the surface of the defect site(Re-epithelialization) using fibrin clot formed in the hemostasis phase. Beneath this layer, the inflammatory cells penetrate the defect site to clear the dead cells and tissue, combat the invading pathogens, and control the healing process by releasing a different kind of chemokines (Inflammation). Meanwhile, the fibroblasts migrate to the wound site and release chemokines to manage wound healing. They produce and release ECM as well. The microenvironment, which different kinds of cells and chemokines have prepared, makes the healing process such a way to regenerate the lost tissue by forming the granulation tissue (Proliferation). But in a chronic wound, poor condition of the ulcer microenvironment halts the healing process in the inflammatory stage. Because of biofilm, the inflammatory cells' load raisesin the ulcer environment, turning it into a devastating condition.

Fig. 3

Extraction and Preparation of PRP and PPP. Peripheral blood of patients could be taken from veins and poured into an anticoagulated centrifuge tube. After the firstspin, the blood would be divided into three layers, the uppermost layer is PPP, the red blood cell layer is at the bottom, and the buffy coat layers at the middle layer. In the next step, by the collection of the two uppermost layers in a new tube and centrifugation for the second time (second spin), the plasma layer would be separated into two layers: PRP and PPP.