Platelet concentrates in diabetic foot ulcers: A comparative review of PRP, PRF, and CGF with case insights

Abstract

Diabetic foot ulcers (DFUs) are severe complications of diabetes, often leading to chronic wounds, amputations, and increased mortality risk. Platelet concentrates (PCs)-natural biomaterials utilized in regenerative medicine-have garnered attention for their capacity to enhance tissue repair and wound healing. This study reviews the preparation methods, biological mechanisms, and clinical efficacy of three generations of PCs: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factors (CGF). Comparative analysis reveals that PRP, the first generation, provides abundant growth factors but relies on anticoagulants, which may hinder fibrin formation and tissue adhesion. PRF, as the second generation, eliminates anticoagulants, forming a fibrin matrix that sustains growth factor release and enhances cell migration. CGF, the latest advancement, employs refined centrifugation to achieve higher growth factor concentrations and a denser fibrin matrix, accelerating tissue regeneration. Case series results demonstrated superior wound healing outcomes with CGF, including faster epithelialization and reduced healing time compared to PRP and PRF. These findings underscore CGF's potential as the most effective PC for managing DFUs, supporting its broader clinical adoption in advanced wound care.

Keywords: Concentrated growth factors; Diabetic foot ulcers; Platelet concentrates; Platelet-rich fibrin; Platelet-rich plasma; Wound healing.

Fig. 1

PRP, PRF, and CGF preparation process.

Fig. 2

PRP treatment for DFU patient with osteomyelitis. a) Ulceration, redness, and swelling with pain in the fifth toe of the left foot. b) after PRP treatment, the wound healed well.

Fig. 3

CGF treatment for elderly DFU patient with severe infection. a) Long-term non-healing of the foot wound after enucleation of necrotic tissue, accompanied by oozing and pus flow. b) treatment with CGF. c) the wound healed well and the limb was successfully preserved.