Level of Evidence on Platelet-rich Plasma in Plastic Surgery

Abstract

Background: Despite the increased popularity of platelet-rich plasma (PRP) in plastic surgery, there is no detailed analysis on the level of evidence on PRP use in plastic surgery. As the number of applications of PRP in plastic surgery increases, it is important for plastic surgeons to understand the scientific and validated evidence behind its use. Therefore, we performed a literature review to identify current level of evidence on platelet-rich plasma in plastic surgery. Methods: We performed a computerized search of platelet-rich plasma in plastic surgery using the MEDLINE, Cochran Library, and EMBASE databases. Data regarding the type of study, PRP application, and outcomes were collected. Then, the level of evidence was assigned using the American Society of Plastic Surgeons Level of Evidence Rating. Results: Our search identified 105 articles, and about 78.1% of studies were lower-quality studies: 37 level-III articles (35.2%), 32 level-IV articles (30.5%), and 13 level-V articles (12.4%). There were only 6 level-I articles and 17 level-II studies. Level-I studies were on facial rejuvenation using a laser, carpal tunnel release, cleft lip repair, trauma wounds, breast reconstruction using latissimus dorsi, and hair regrowth. Conclusions: Our review of the literature shows that the level of evidence on PRP use in plastic surgery is low (21.9%). Nevertheless, we believe level-III to level-V studies are still valuable, as performing high-level quality studies in plastic surgery is difficult due to variability in surgical techniques, experiences, and materials.

Bone Graft Substitutes and Enhancement in Craniomaxillofacial Surgery

“…These platelet products contain cytokines and growth factors that have been studied broadly in craniofacial literature in both hard and soft tissues. 69 PRP is isolated via centrifugation of blood and collection of the denser, higher platelet concentration plasma fraction. PRP contains various growth factors such as platelet-derived growth factor (PDGF), insulinlike growth factor, TGF-beta, and VEG-F.…”

Clinical therapeutic effects of platelet-rich plasma in patients with burn wound healing

“…An intricate network of signals between different types of cells is formed during the different stages of tissue healing, which includes cytokine secretion, development factors, and collagen matrices [8] . Reportedly, platelet-rich plasma (PRP) has been used as a form of treatment for a range of diseases with positive outcomes, which includes surgery, knee osteoarthritis, diabetic ulcers, etc [9–11] . Recent researches involving PRP have shed some light on its potential clinical application to treat burn wounds.…”

“…[8] Reportedly, platelet-rich plasma (PRP) has been used as a form of treatment for a range of diseases with positive outcomes, which includes surgery, knee osteoarthritis, diabetic ulcers, etc. [9][10][11] Recent researches involving PRP have shed some light on its potential clinical application to treat burn wounds. Yet, there haven't been any attempts to logically assess the medical benefits of PRP for treating and healing burn wounds.…”