Regenerative Surgery: Use of Fat Grafting Combined with Platelet-Rich Plasma for Chronic Lower-Extremity Ulcers

Original Article

Abstract

Background

The authors present their experience with reconstructive surgery of the lower extremity for chronic ulcers, evaluating the effects related to the use of a platelet-rich plasma combined with fat tissue.

Methods

A total of 20 patients, 25 to 50 years of age (median age, 40 years), have been managed with platelet gel in the Plastic and Reconstructive Surgery Department at the “Tor Vergata,” University of Rome. The patients were affected by both lower-extremity chronic ulcers and vascular disease.

Results

The authors observed that 16 of 20 chronic lower-extremity ulcers reepithelialized during an average of 9.7 weeks, with platelet releasate suspended on a collagen base (platelet-derived wound-healing factor), compared with 2 of 10 similar wounds treated with medication based on hyaluronic acid and collagen. Collectively, these data provide evidence for the clinical use of platelet technology in the healing of both soft and hard tissue wounds.

Conclusions

Currently, plastic surgery with autogenous fat grafts can be performed for stabilization of chronic lower-extremity ulcers. The objective of this study was, through the presentation of clinical cases, to suggest a therapeutic plan formed by two sequential treatments: acquisition of platelet gel from a small volume of blood (9–18 ml) followed by the Coleman technique for reconstructing the three-dimensional projection and superficial density of tissues. The results proved the efficacy of combining these two treatments, and the satisfaction of the patients confirmed the quality of the results.

Keywords

Lipostructure Lower-extremity ulcers Platelet-rich plasma 

References

  1. 1.
    Rejan TJ (1993) The epidemiology of leg ulcers. In: Westerhof W (ed) Leg ulcers: diagnosis and treatment. Elsevier Science Publishers BV, Amsterdam, pp 19–27Google Scholar
  2. 2.
    Baker SR, Stacey MC, Jopp-McKay AG, Hoskin SE, Thompson PJ (1991) Epidemiology of chronic venous ulcers. Br J Surg 78:864–867PubMedCrossRefGoogle Scholar
  3. 3.
    Margolis DJ, Bilker W, Santanna J, Baumgarten M (2002) Venous leg ulcer: incidence and prevalence in the elderly. J Am Acad Dermatol 46:381–386PubMedCrossRefGoogle Scholar
  4. 4.
    Phillips TJ (1994) Chronic cutaneous ulcers: etiology and epidemiology. J Invest Dermatol 102:38S–41SPubMedCrossRefGoogle Scholar
  5. 5.
    Miller OFIII, Phillips TJ (2000) Leg ulcers. J Am Acad Dermatol 43(1 Pt 1):91–95PubMedCrossRefGoogle Scholar
  6. 6.
    Callam MJ, Harper DR, Dale JJ, Ruckley CV (1987) Chronic ulcer of the leg: clinical history. Br Med J (Clin Res Ed) 294:1389–1391CrossRefGoogle Scholar
  7. 7.
    Azzena B, Mazzoleni F et al (2008) Autologous platelet-rich plasma as an adipocyte in vivo delivery system: case report. Aesth Plast Surg 32:155–158; discussion 159–161Google Scholar
  8. 8.
    Anitua E, Aguirre JJ et al (2008) Effectiveness of autologous preparation rich in growth factors for the treatment of chronic cutaneous ulcers. J Biomed Mater Res B Appl Biomater 84:415–421PubMedGoogle Scholar
  9. 9.
    Valencia IC, Falabella A, Kirsner RS, Eaglstein WH (2001) Chronic venous insufficiency and venous leg ulceration. J Am Acad Dermatol 44:401–421PubMedCrossRefGoogle Scholar
  10. 10.
    Coleridge SP, Scurr J (1991) Current views on the pathogenesis of venous ulceration. In: Bergan JJ, Yao JS (eds) Venous disorders. Saunders, Philadelphia, pp 46–51Google Scholar
  11. 11.
    Wilkinson LS, Bunker C, Edwards JC, Scurr JH, Smith PD (1993) Leukocytes: their role in the etiopathogenesis of skin damage in venous disease. J Vasc Surg 17:669–775PubMedCrossRefGoogle Scholar
  12. 12.
    Anitua E, Sanchez M et al (2007) The potential impact of the preparation rich in growth factors (PRGF) in different medical fields (review). Biomaterials 28:4551–60; Epub 2007 Jul 30Google Scholar
  13. 13.
    Mani R, White JE, Barrett DF, Weaver PW (1989) Tissue oxygenation, venous ulcers, and fibrin cuffs. J R Soc Med 82:345–346PubMedGoogle Scholar
  14. 14.
    van Rij AM, Solomon C, Christie R (1994) Anatomic and physiologic characteristics of venous ulceration. J Vasc Surg 20:759–764PubMedGoogle Scholar
  15. 15.
    Coleman SR (2006) Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 118(3 Suppl):108S–120SPubMedCrossRefGoogle Scholar
  16. 16.
    Coleman SR (1995) Long-term survival of fat transplants: controlled demonstrations. Aesth Plast Surg 19:421–425CrossRefGoogle Scholar
  17. 17.
    Coleman SR (2001) Structural fat grafts: the ideal filler (review)? Clin Plast Surg 28:111–119PubMedGoogle Scholar
  18. 18.
    Weibrich G, Kleis WK, Hitzler WE, Hafner G (2005) Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: a technical report. Int J Oral Maxillofac Implants 20:118–123PubMedGoogle Scholar
  19. 19.
    Pietramaggiori G, Scherer SS et al (2008) Healing modulation induced by freeze-dried platelet-rich plasma and micronized allogenic dermis in a diabetic wound model. Wound Repair Regen 16:218–225PubMedCrossRefGoogle Scholar
  20. 20.
    Rozman P, Bolta Z (2007) Use of platelet growth factors in treating wounds and soft tissue injuries (review). Acta Dermatovenerol Alp Panonica Adriat 16:156–165PubMedGoogle Scholar
  21. 21.
    Krasna M, Domanović D, Tomsic A, Svajger U, Jeras M (2007) Platelet gel stimulates proliferation of human dermal fibroblasts in vitro. Acta Dermatovenerol Alp Panonica Adriat 16:105–110PubMedGoogle Scholar
  22. 22.
    Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT (2004) Autologous platelets as a source of proteins for healing and tissue regeneration (review). Thromb Haemost 91:4–15PubMedGoogle Scholar
  23. 23.
    Anitua E, Sánchez M et al (2006) New insights into and novel applications for platelet-rich fibrin therapies (review). Trends Biotechnol 24:227–234; Epub 2006 Mar 15Google Scholar
  24. 24.
    Frechette JP et al (2005) Platelet rich plasmas: growth factor content and roles in wound healing. J Dent Res 84:434–439PubMedCrossRefGoogle Scholar
  25. 25.
    Everts PA et al (2006) Platelet-rich-plasma and platelet gel: a review. J Extra Corpor Technol 38:174–178PubMedGoogle Scholar
  26. 26.
    Brown RL et al (1994) PDGF and TGF-alpha act synergistically to improve wound healing in the genetically diabetic mouse. J Surg Res 56:562–570PubMedCrossRefGoogle Scholar
  27. 27.
    Rigotti G, Marchi A et al (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 119:1409–1422; discussion 1423–1444Google Scholar
  28. 28.
    Rehman J, Traktuev D, Li J et al (2004) Secretion of angiogenic and antiapoptotic factors by human adipose stromal cells. Circulation 109:1292PubMedCrossRefGoogle Scholar
  29. 29.
    Cao Y, Sun Z, Liao L et al (2005) Human adipose tissue-derived stem cells differentiate into endothelial cells in vitro and improve postnatal neovascularization in vivo. Biochem Biophys Res Commun 332:370PubMedCrossRefGoogle Scholar
  30. 30.
    Cullum N, Nelson EA, Fletcher AW, Sheldon TA (2001) Compression for venous leg ulcers. Cochrane Database Syst Rev (2):CD000265Google Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2009

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryUniversity of Tor VergataRomeItaly
  2. 2.RomeItaly

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