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Intra-tendinous platelet rich plasma injection therapy for healing wounds with exposed tendons: a clinical case series

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Platelets are rich in cytokines and growth factors. Exposed tendons in wounds do not naturally heal by granulation and epithelization. The study aimed to explore the effects of PRP injection therapy on exposed tendons in open wounds and determine if the tendon could support wound healing.

Methods

A retrospective observational clinical study was undertaken from 2012 to 2018 to assess wound healing from exposed tendons in wounds in patients treated with PRP injections and occlusive dressings. Parameters studied included patient and management factors, wound and functional outcomes, wound healing progression, and the direct effects of PRP therapy on tissues.

Results

Twenty-three patients with several comorbidities received treatment. The average age of patients was 56 years, with an age range of 25 to 79 years. Twenty of the 23 patients (87%) reached complete healing. Eighteen of the 20 (90%) had good tendon excursion and associated joint movement for the limb’s function. The complication rate was low. PRP injection therapy produced a response of increased vascularity, the proliferation of granulation tissue from the tendon, and epithelialization from the surrounding skin.

Conclusions

Intra-tendinous PRP injections used with occlusive dressings can heal the exposed tendon and open wound by process of granulation and epithelization, restoring adequate limb function.

Level of evidence: Level IV, Therapeutic study.

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Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Nelson R Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Ward D2East, Private bag X03, Mayville, Durban, 4058, South Africa

    Mahendra Daya

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Correspondence to Mahendra Daya.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The university’s Biomedical Research Ethics Committee approved the study—number BE299/15.

Informed consent

All patients included in the study provided written informed consent for surgical procedures and PRP treatment. Patients provided written consent for the use of photographic and video records for publication.

Conflict of interest

Mahendra Daya declares no conflict of interest.

Funding

No funds, grants or other financial support was received.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 Case 1 is a patient with a snake bite injury, developed exposed extensor tendons on the dorsum of the hand. The video shows the wound's progress on treatment and the excellent hand function demonstrated by the near-normal range of active joint movement and tendon excursion one year after healing.(MP4 258 MB)

Supplementary file1 Case 2 is a patient who developed suture line breakdown and skin necrosis following partial ankle joint replacement using an anterior approach. The tibialis anterior tendon became exposed. The video shows the wound's progress on treatment and ankle function achieved by one year after healing. The patient achieved pain-free ambulation with a normal gait.(MP4 150 MB)

Supplementary file1 Case 4 is a patient with bilateral dog-bite injuries to both lower legs at the ankle region. The right leg required a free flap for the reconstruction, and the left leg for the tissue loss and exposed tibialis anterior tendon received PRP therapy. The video at two years after healing shows good ankle function.(MP4 356 MB)

Supplementary file1 Case 5 is a patient with soft tissue radio-necrosis of the anterior aspect of the leg. Skin loss resulted in the exposure of the tibialis anterior and peroneal tendons. After debridement, PRP injections of the exposed tendons began. The purpose of the video is to show the injection technique of administering PRP to the tendons, case history and clinical progress, changes seen in tendon vascularity, increase in granulation tissue production and the spontaneous wound epithelialization seen in the wound. The gradual increase in bleeding seen on injecting the tendons over time was seen in all patients successfully treated using PRP injections. The bleeding points seem to precede the development of granulation islands in the tendon.(MP4 344 MB)

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Daya, M. Intra-tendinous platelet rich plasma injection therapy for healing wounds with exposed tendons: a clinical case series. Eur J Plast Surg 46, 387–396 (2023). https://doi.org/10.1007/s00238-022-02001-9

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  • DOI: https://doi.org/10.1007/s00238-022-02001-9

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