Study design: Prospective clinical case series. Objectives: The objective of this study is to evaluate the local application of platelet-rich plasma (PRP) in relation to pressure ulcers (PrUs) healing on one PrU (case) versus saline dressing on another PrU (control) in the same patient. Setting: Tertiary Level Care Centre, India. Methods: Twenty-five spinal cord injury patients with at least two PrUs were included. All 25 PrUs (case) were grade IV, and PrUs (control) were grade II (n ¼ 11), grade IV (n ¼ 10) and grade III in 4 patients. Evaluation of PrU healing was done by measuring wound surface area, Pressure Ulcer Scale for Healing (PUSH), biopsy and clinical examination. Results: Statistically significant decrease in mean PUSH scores of PrUs (case) (t ¼ 6.13, Po0.000) and PrUs (control) (t ¼ 3.98, P ¼ 0.000) was observed after 5 weeks. The wound surface area of PrU (case) decreased significantly (t ¼ 4.98, P ¼ 0.000); however, the decrease was not significant (t ¼ 0.095, P ¼ 0.924) in PrUs (control). Majority of histopathological pictures of PrUs (case) showed necrosis and suppuration (56%) at the time of enrollment and well-formed granulation tissue and epithelialization (60%) at the 5th week. Twenty-four (96%) PrUs (case) improved and only 1 deteriorated with PRP therapy, whereas in control group 17 (68%) PrUs improved, 7 (28%) deteriorated and 1 wound showed no change. Conclusions: Advanced wound therapy using local applications of PRP seems to be a promising alternative to standard saline dressings in PrU healing. With the advantages of simple preparation, biocompatible safety, low cost and significant clinical effectiveness, it may be beneficial to study the effects of PRP in large-scale trials to validate it as an ideal therapy for enhanced wound healing in PrUs.

Background. Exposure of pressure ulcers (PrUs), particularly to urine and feces, leads to increased colonization of wounds. The aim of the present study was to evaluate the source of microbial colonization and antimicrobial properties of autologous platelet rich plasma (PRP) in controlling it in PrUs. Methods. Twenty-five patients of spinal cord injury (SCI) with at least two PrUs were taken for the study. Local application of autologous PRP on one PrU (case) was compared with saline dressing on the other PrU (control). Urine cultures, urethral meatus, PrUs, and perineal swabs were taken at weekly interval for five weeks. Result. Colonization rate of PrUs (case) decreased from 92% at enrollment to 24% at the 5th week but did not significantly decrease in PrUs (control) from enrollment (84%) to the 5th week (76%). Association between PrU (case) and perineal cultures was observed for Staphylococcus aureus at enrollment 41% ( 2 = 6.76, < 0.01) and at the 2nd week 47% ( 2 = 5.83, < 0.05). 47% association between PrU (control) and perineal cultures at enrollment ( 2 = 4.11, < 0.05) and 29% association at the 2nd week ( 2 = 8.41, < 0.01) were observed for Staphylococcus aureus. There was association between bacteria present in perineum/urine and those colonizing PrUs. Conclusion. There is a significant association between PrUs colonization and bacteria present in local environment (urine and feces). Local application of autologous PRP changes the "biological milieu" of the PrUs through its antimicrobial properties leading to reduction in bacterial colonization.