Addition of platelet concentrate to Dermo-Epidermal Skin Graft in deep burn trauma reduces scarring and need for revision surgeries

Abstract

Backround Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues. Methods We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses. Results We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings. Conclusions Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1–3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1–7 days), which normalized over the subsequent 7 and 90 days.

Use of platelet‐rich plasma to facilitate wound healing

“…There are a number of studies showing that the use of autologous PRP can improve the results of wound‐healing processes, as well as in cases of poorly healing wounds. Several controlled studies have given statistically significant evidence that the use of PRP leads to the acceleration of wound healing . There are three controlled studies on humans that reported of improvement of wound healing with regard to healing time, the quality of life, and reduction of pain .…”

“…Several controlled studies have given statistically significant evidence that the use of PRP leads to the acceleration of wound healing. [16][17][18][19][20][21][22][23][24][25][26] There are three controlled studies on humans that reported of improvement of wound healing with regard to healing time, the quality of life, and reduction of pain. 17,18,25 According to a prospective controlled study of Hom et al, epithelialisation and granulation formation appeared 3 days earlier in the experimental group where PRP was used, 16 while it was established in our study that granulation formation also started 3 days earlier and epithelialisation 4 to 6 days earlier in the treatment group.…”

The application of platelet‐rich plasma in the treatment of deep dermal burns: A randomized, double‐blind, intra‐patient controlled study

“…Finally, a cohort study in 18 burn patients treated with a split thickness skin graft (SSG) and autologous platelet concentrate, resulted in less pain and earlier discharge compared with institutional controls who did not receive SSG with autologous platelet concentrate. However, this control group was described insufficiently …”

Platelet-Rich Plasma in Burn Treatment

“…Additionally, recently some reports were published with positive results of PRP in combination with adipose cells for scar treatment; therefore, there might be an indication for PRP in the reconstructive aspect of burn treatment. On the other hand, in another study, long-term follow-up results did not show significant differences in scar quality in patients treated with PRP combination [86].…”