Effectiveness of injected versus topically applied platelet-rich plasma in diabetic foot ulcers: A randomized controlled trial with clinical and histopathological assessment

Abstract

Background: Diabetic foot ulcers (DFUs) are a serious complication of diabetes that can lead to significant morbidity. Autologous platelet-rich plasma (PRP), rich in growth factors and cytokines, has emerged as a promising treatment to enhance ulcer healing. This study aimed to compare the clinical and histological efficacy of injected PRP versus topically applied PRP and traditional wound care in the management of DFUs.

Methods: Sixty patients with DFUs were randomly assigned to three equal groups (n = 20 each). Group A received locally injected autologous PRP; Group B received topically applied autologous PRP; and Group C received standard wound care. All patients were followed twice weekly for 12 weeks or until complete healing. Skin biopsies were obtained at baseline and after 12 weeks (or upon completion for unhealed ulcers) for histopathological evaluation.

Results: By the end of the 12-week follow-up, 87.5 % of patients treated with PRP (35 out of 40 in Groups A and B) achieved complete ulcer healing, compared to a significantly lower healing rate in the traditional care group (Group C). Histological findings supported the clinical outcomes. No significant difference was found between injected and topically applied PRP in terms of clinical effectiveness. Conclusion: PRP treatment, whether injected or topically applied, significantly enhances the healing of DFUs compared to traditional wound care. Both methods of PRP application demonstrated comparable clinical efficacy.

Keywords: Diabetic foot ulcer; Histopathology; Platelet-rich plasma (PRP); Topical PRP; Wound healing.

Figure 1

Photomicrograph of Sections in skin: a (Initial specimen showed erythrocyte exudation and ulcer margin with fibrinous exudate in the base of the ulcer and degeneration of the vessel wall). b (Injected PRP specimen showed re-epithelialization, neovascularization, and granulation tissue formation [H&E x400]).

Figure 2

Photomicrograph of sections in skin: a (Initial specimen showed limited Collagen fibers and fibroblasts or myofibroblasts). b (Injected PRP specimen showed different variants of fibroblast co-localization with marked formation of collagen fibers and granulation tissues [Mallory stain x400]).

Figure 3

Photomicrograph of sections in skin of: a (Topical PRP specimen showed moderate PCNA protein expression level). b (Ordinary treated specimen showed minimal PCNA protein expression level. [PCNA x200]).

Figure 4

Mean values of the optical density of Mallory's trichrome stain (detect collagen fibers) in the skin tissue for the different groups of the study.

Figure 5

Mean values of the optical density of PCNA in the in the skin tissue for the different groups of the study.