Efficacy of Combined Use of PELNAC and Platelet-rich Plasma in Promoting Wound Healing

Abstract

Background: Artificial dermis is useful for treating full-thickness skin defects but requires a long time to form dermis-like granulation tissue. This study investigated whether platelet-rich plasma (PRP) combined with PELNAC, a collagen-based artificial dermis, promotes wound healing and examined the underlying mechanism.

Methods: Two 1-cm² full-thickness skin defects were created in 8-week-old male nude rats (n = 8). One defect received saline-impregnated PELNAC (control group); the other received PRP-impregnated PELNAC (combination group). Cytokine levels in PRP were measured. Wound area measurements and histological and immunohistochemical evaluations (transforming growth factor-β1 [TGF-β1], vascular endothelial growth factor [VEGF], α-smooth muscle actin, and von Willebrand factor) were performed on day 14.

Results: Compared with the control group, the combination group showed a significantly reduced wound area (32.4 ± 14.89 versus 68.3 ± 14.9 mm², P < 0.001) and increased dermis-like granulation tissue thickness (947 ± 219 versus 448 ± 165 μm, P < 0.001). Expression of TGF-β1 (8.9% ± 1.7% versus 4.2% ± 1.2%, P < 0.0001) and VEGF (4.4% ± 1.2% versus 1.9% ± 0.5%, P < 0.0001) was significantly higher in the combination group, whereas α-smooth muscle actin-positive cells and von Willebrand factor-positive blood vessels showed no significant differences.

Conclusions: The combined use of PELNAC and PRP accelerated dermis-like granulation tissue formation through increased expression of VEGF and transforming growth factor-β1, significantly improving wound healing. This combination therapy could be easily applied in clinical practice and may contribute to shortening healing times for deep dermal defects.

Fig. 1.

Experimental design and surgical procedure. Overview of the experiment. The procedures for preparing PRP from whole blood, preparing PELNAC grafts for the control and combination groups, and transplanting the grafts into nude rats are shown. In the first operation, full-thickness skin defects, each measuring 1 × 1 cm, were created on the backs of 8-week-old nude rats (n = 8). Created with BioRender (Fujimaki, 2025). Available at https://BioRender.com/gfm92ue.

Fig. 2.

Gross and histological evaluation. A, B, Gross findings of the control and combination groups at 14 days postoperatively. C, Quantitative evaluation of wound area (***P < 0.01). D, E, Histological evaluation by Masson trichrome staining. The arrows indicate the thickness of dermis-like granulation tissue. F, Quantitative evaluation of the thickness of dermis-like granulation tissue (**P < 0.01).

Fig. 3.

Immunohistochemical evaluation. The expression of different markers in the control and combination groups is shown. Images of tissue sections immunostained for (A, B) TGF-β1, (D, E) VEGF, (G, H) α-SMA, and (J, K) vWF. Scale bars, 1000 μm. C, F, I, L, Quantitative evaluation results for each marker are shown. ***P < 0.01. ns, not significant.