A substantial percentage of non-healing, chronic wounds fail to heal, even under expert care by wound specialist providers, necessitating the application of special care, involving “Advanced Modalities,” such as Hyperbaric Oxygen Therapy, and Engineered Dermal Substitutes, sometimes referred to as “synthetic skin.” While such “Advanced Modalities” can provide significant benefits to patients, they are expensive, not universally available, and reimbursement for their use is quite restrictive.
At present, third-party payers restrict reimbursement for engineered grafts to specific wound types and locations; namely Diabetic Foot Ulcers, and Venous Leg Ulcers, and restrict Hyperbaric Oxygen Therapy, as a chronic wound treatment modality to Diabetic Foot Ulcers, and chronic, radiation-related wounds.
Those site and etiology-based restrictions leave many patients with diabetes who also have non-healing ulcers of sites other than the foot, bereft of options. Fortunately, an exciting new option is available for diabetic patients with non-healing ulcers at any site, as long as non-healing is related to underlying complications of diabetes, such as microvascular disease, white blood cell, or fibroblast dysfunction.
The technology we are referring to is Platelet Rich Plasma or PRP, which is not a “new technology,” per se. In fact, PRP has a proven track record in regenerative medicine, and particularly within orthopedic medicine, where it has been used for more than a decade to improve outcomes in patients with complex tendon, muscle, bone and joint problems. In fact, the very basis for the successful application of PRP to orthopedic problems underlies its benefits as an Advanced Modality in wound care.
From a technical standpoint, PRP is a biologically derived product — a type of Autograft — sourced from the patient's own blood. Using a simple process that can be quickly performed in the wound clinic, the patient’s blood is utilized to create a jelly-like graft material that is enriched with growth factors, activated platelets, fibrin, and other bioactive elements essential for tissue repair and regeneration.
Not only does PRP provide a potential solution for diabetic patients without other reimbursable treatment options, it provides a unique combination of benefits that are not seen with existing solutions, such as amniotic grafts. These benefits include:
1. Tissue Regeneration: PRP accelerates the body's natural healing processes via endogenous, patient-derived cytokines, promoting the regeneration of damaged tissue by enhancing synthesis of new blood vessels, and collagen synthesis, both of which are necessary prerequisites for wound healing.
2. Infection Control: PRP exhibits inherent antimicrobial properties, which contribute to infection control within the wound environment, creating a conducive setting for healing, and offsetting some of the detriments to wound healing posed by biofilms — bacterial structures that are found in most, chronic wounds that strongly inhibit healing.
3. Inflammation Modulation: PRP also plays a role in modulating the inflammatory response, a pivotal factor in the pathophysiology of chronic wounds, thus facilitating the healing process.
4. Scar Reduction: Notably, PRP therapy has demonstrated the potential to minimize scarring and improve cosmetic outcomes, a welcome benefit for patients concerned about aesthetic consequences.
The PRP Treatment Protocol is straightforward, and easily repeatable by wound clinic personnel after brief training, and consists of the following, simple steps:
1. Blood Collection: A modest volume of the patient's blood is drawn, mirroring the process employed for standard blood test specimen collection.
2. Centrifugation: The blood sample undergoes centrifugation to isolate PRP from other blood constituents.
3. Application: The concentrated PRP is applied directly to the wound site, and can also be applied via targeted injection, depending on wound characteristics and anatomical considerations. The jelly-like consistency of PRP lends itself to application to complex wound shapes, and sinus tract wounds that would be difficult to cover with planar or sheet materials.
4. Dressing and Monitoring: Following PRP application, an appropriate wound dressing is applied, and close monitoring is conducted to assess the progress of wound healing.
Conclusion
In Platelet Rich Plasma (PRP) therapy, we have a noteworthy addition to our arsenal of wound care strategies. It offers a hope for a wider range of individuals grappling with non-healing, chronic wounds. By harnessing the body's inherent regenerative capabilities, PRP promises expedited wound closure, a reduction in complications, and an improvement in overall quality of life. As we navigate this therapeutic landscape, we stand at the precipice of innovation, holding the potential to significantly enhance patient outcomes and usher in a new era in the domain of wound management. Embracing this emerging approach represents an opportunity for substantive improvements in the treatment of chronic wounds and a reconfiguration of established paradigms in the field.
Marcus Gitterle, MD, FACCWS, ABWM
Chief Medical Officer
WoundCentrics, LLC