In lower-extremity surgery, the complex wound with bone exposure remains a challenging problem for the plastic surgeon. The purpose of this study was to describe a new therapeutic approach to stimulate the regeneration of the lower-extremity complex wounds based on a combined treatment composed of platelet-rich plasma (PRP) and hyaluronic acid (HA) dressing.
DESIGN: Wounds with posttraumatic bone exposure have been treated with HA dressing alone or in combination with PRP.
PATIENT: Fifteen patients affected by lower-extremity wound with posttraumatic bone exposure have been treated at the Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome, Italy.
RESULTS: After a single treatment, the authors observed that the mean re-epithelialization time was 8.1 weeks in 73.3% patients treated with PRP and HA dressing versus the 30% patients treated with HA dressing only.
CONCLUSION: These data confirm the evidence of using PRP technology in the healing of both soft- and hard-tissue wounds. Moreover, the satisfaction of the patient confirms the quality of this study’s results.
Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is an uncommon degenerative and poorly understood condition. It is characterized by a slow and progressive atrophy affecting one side of the face. The incidence and cause of this alteration are unknown, and the pathogenesis of the syndrome is not clear. Some authors attribute the atrophy of the subcutaneous system to an alteration of the sympathetic system. Others attribute it to an alteration of the nervous system at the encephalic level or to an interstitial neuritis of the trigeminal nerve. The most common complications that appear in association with this disorder are trigeminal neuritis, facial disorders, and epilepsy. The latter is the most frequent complication of the central nervous system. Characteristically, the atrophy progresses slowly for several years and soon becomes stable. After stabilization of the disease, plastic surgery of autogenous fat grafts can be performed. This study aimed through the presentation of clinical cases to suggest a therapeutic plan comprised of two sequential treatments: aquisition of platelet gel from a small volume of blood (9 ml) followed by the Coleman technique for reconstructing the three-dimensional projection of the face contour, restoring the superficial density of the facial tissues. The results obtained prove the efficacy of these two treatments combined, and the satisfaction of the patient confirms the quality of the results.
Platelet-rich plasma (PRP) has long been known as an effective treatment in various surgical and medical fields. Face and neck revitalization with PRP is an application that is currently being explored. The aim of this paper is practical: to evaluate if there are real outcomes, benefits and side effects of a standardized injection protocol in a continuous series, without control groups.
MATERIALS AND METHODS:
In a three-month study, a consecutive series of 23 patients were treated with one session of injections with PRP every month from September 2008 to December 2008 (a total of three sessions). For blood management, a sterile Regen Lab Kit was used. Patients received 4 mL of PRP, activated with calcium chloride, at standard injection points into face and neck skin. The study was documented with imaging before and after each session using a dermoscope, a digital camera, as well as a comprehensive state-of-the-art imaging system and dedicated medical imaging software.
The results were evaluated one month after the last session (January 2009) by a special spider improvement score, a photograph score, a patient’s satisfaction score and a doctor’s satisfaction score. Finally, a definitive graduated score was calculated for each patient. Overall, the results were satisfactory. No serious and persistent side effects were detected.
Face and neck revitalization with PRP is a promising easy-to-perform technique in face and neck rejuvenation and scar attenuation. Further work needs to be carried out to investigate its exact mechanism of action.
OBJECTIVE:To evaluate the histological changes induced in human skin by injection of autologous platelet-rich fibrin matrix (PRFM).
METHODS: Four healthy adult volunteers were included in the study. Platelet-rich fibrin matrix was prepared from 9 mL of autologous blood using a proprietary system (Selphyl; Aesthetic Factors, Wayne, New Jersey) and injected into the deep dermis and immediate subdermis of the upper arms of subjects. Full-thickness skin biopsy specimens were taken from the treated areas over a 10-week period, and the specimens were processed for histological evaluation.
RESULTS: Findings from histological examination supported the clinical observation of soft-tissue augmentation. As early as 7 days after treatment, activated fibroblasts and new collagen deposition were noted and continued to be evident throughout the course of the study. Development of new blood vessels was noted by 19 days; also at this time, intradermal collections of adipocytes and stimulation of subdermal adipocytes were noted. These findings became more pronounced over the duration of the study, although the fibroblastic response became much less pronounced. No abnormal mitotic figures were observed at any point, and a very mild chronic inflammatory response was noted only at the earliest time points of the study.
CONCLUSIONS: Injection of PRFM into the deep dermis and subdermis of the skin stimulates a number of cellular changes that can be harnessed for use. Coupled with prior in vitro and in vivo studies, we now have a much clearer picture of the cellular effects of PRFM and its potential uses in facial plastic surgery. Further work is planned to more clearly elucidate the potential role of PRFM in aesthetic and reconstructive surgery.