The use of autologous platelet–leukocyte gels to enhance the healing process in surgery, a review

Abstract

Background: The therapeutic use of autologously prepared, platelet-leukocyte-enriched gel (PLG) is a relatively new technology for the stimulation and acceleration of soft tissue and bone healing. The effectiveness of this procedure lies in the delivery of a wide range of platelet growth factors mimicking the physiologic wound healing and reparative tissue processes. Despite an increase in PLG applications, the structures and kinetics of this autogenously derived biologic material have not been observed. Methods: A review of the most recent literature was performed to evaluate the use of PLG in various surgical disciplines. Results: The review showed that the application of PLG has been extended to various surgical disciplines including orthopedics, cardiac surgery, plastic and maxillofacial surgery, and recently also endoscopic surgery. Conclusion: This review demonstrates the usefulness of PLG in a wide range of clinical applications for improvement of healing after surgical procedures.Key words: Growth factors -Leukocytes -Platelet gel -Wound healing Soft tissue wound healing and bone growth involve physiologic cascades in which cellular and hormonal factors play pivotal roles [1,2]. Some of these cascade components can be isolated from autologously drawn whole blood. Point-of-care devices can intraoperatively fractionate the autologous blood into platelet-poor plasma, platelet-leukocyte-rich plasma (P-LRP), and red blood cells [3,4]. The P-LRP fraction, a mixture of concentrated platelets and leukocytes, can be activated by (autologous) thrombin to create a viscous solution known as platelet-leukocyte gel (PLG). This platelet coagulum can be exogenously applied to soft wound tissues, bone, or synthetic bone as a spray or as a solid, clotted, gelatinous mass. The rationale for applying platelet gel is based on the delivery of platelet growth factors to tissues and on the fact that platelet a-granules, found inside the platelets, contain a variety of growth factors [5]. Platelet gel growth factors are peptides that promote cell proliferation, differentiation, chemotaxis, and the migration of various cells involved in both wound healing and bone growth [6,7].Recently, numerous P-LRP devices have become available for therapeutic use to stimulate and accelerate soft tissue and bone healing and to control postoperative wound bleeding. The rationale for applying PLG lies in the mimicking and accelerating of physiologic wound healing and reparative tissue processes.This article provides information on the results of electron microscopic imaging used to evaluate the content of PLG. Furthermore, because the use of PLG is a relatively new per-and/or perioperative biotechnological application, new and additional indications for the use of PLG are defined. New PLG applications are reviewed for different applications including cardiac surgery, general surgery, orthopedics and traumatology, cosmetic surgery, maxillofacial surgery, sports medicine, and endoscopic surgical procedures. Defining platelet-leukocyte-rich...

Effects of platelet rich plasma on fascial healing in rats with fecal peritonitis

“…These findings in consistence with literature that PRP increases growth factors and through this mechanism speeds up wound healing 27,28 . In many studies that have been carried out, concentrated growth factors have been found to speed up wound healing at a rate of 30-40% 29,30 .…”

No positive bone healing after using platelet rich plasma in a skeletal defect. An observational prospective cohort study

“…In addition, it possesses antimicrobial properties that may contribute to the prevention of infections [2].…”

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“…In this environment, the biologically active proteins might bind to specific platelet growth factor receptors present in surgical tissues. Released growth factors interact and bind with the platelet tyrosine kinase receptor (TKR), which is present in the cell membranes of tissue cells (ligand-receptor interaction) (21). Therefore, the actual binding site is on the outer surface of the cell membrane, and thus not directly on the cell nucleus.…”