Platelet rich fibrin in treatment of non healing ulcers

1. Platelet concentrate techniques

2. • In 1970 various methods fibrin adhesives was
described
• In 1974 regenerative properties of platelets
were described by Ross et al
• Various practices of using platelet
concentrates and fibrin adhesives were in
practice from 1970s
• In 2001 , Chorkoun et al described techique of
PRF

3. Role of platelets in wound healing
• release of subendothelial factors that attract
circulating platelets and activate coagulation
proteins
• Platelets aggregate and adhere and release
granules containing serotonin, thromboxane, and
adenosine, and initiate coagulation and the
formation of fibrin
• Activation platelets by thrombin causes
hemostatic plug formation
• thrombin-dependent cell activation and platelet
dependent angiogenesis

4. • Platelet derived growth factor
– Enhances proteoglycan and collagen synthesis
– Recruits macrophages and fibroblasts
• Endothelial growth factor
– Angiogenesis by endothelial migration
– Stimulates collagenase secretion by fibroblasts to remodel
matrix
• TGF B
– Promotes angiogenesis
– Establishes chemoattractant gradients,
– induces adhesion molecule expression,
– promotes proinflammatory
– stimulate leukocyte and fibroblast migration
– Induces extracellular matrix synthesis by inhibiting
protease activity and upregulating collagen and
proteoglycan synthesis

5. Fibrin
• Final product of coagulation cascade
• Forms the three dimentional mesh for platelet
aggregation and futher collagen deposition
and fibroblast migration
• Rich in plasma and alpha granules

6. Platelet rich plasma

7. • Step 1- venous blood colleceted with
anticoagulant
• Step2- soft spin
• Step3- PPP and PRP aspirated and collected in
other tube without anti coagulant
• Step 4 – Hard spin
• Step 5 – discard PPP, rest is gently shaken
• Step 6- add bovine thrombin and calcium chloride

8. • cPRP is obtained either in gel or spray form
• Can be made into cPRP membrane by adding
fibrin adhesives

9. Presence of WBCs in PRP
• Advantage
– Better inflamatory reaction – infection control and
better results in wounds with some devitalised
tissues
• Disadvantage
– Delay regenerative process
– Cytotoxic destruction
– Suppress bone healing

10. Buffy coat system Vs Plasma based
systems
Buffy coat systems
Plasma based systems

11. Properties
• Denser polymerisation
• Cytokines effect is time limited
• Good adhesive and hemostatic property
• Cytokine release too quick to be incorperated
in fibrin clot.
• Clinical results tends to be similar to fibrin
adhesives

12. • Full and split-thickness skin grafts donor sites
andrecipient sites
• Skin flaps
• Bone grafts
• Metal implants
• Tissue expansion
• Reconstructions

13. • Recurrent Hernia Repair
• Anal Fistula
• Sternotomy
• Total Hip Replacement
• Total Knee Replacement
• Scoliosis Repair
• Spinal Fusion
• All Open and Internal Reduction Fixation
• Radical neck dissection

14. Plasma rich fibrin
• First developed in France by Choukroun et al
in 2001 for maxilo facial surgeries
• To avoid all the restrictions of the French law
related to blood-derived product
reimplantation

15. Technique
• Venous blood collected in 10ml tubes without
any anticoagulant
• Centrifuge for 15minutes at 3000RPM

17. PRF advantages
• No biochemical handling of blood
• Simplified and cost effective
• Use of bovine thrombin and antocoagulants
not required
• Slow polymerisation
• More efficient cell migration and proliferation
• Favourable interacion with immune system

18. Clinical uses
• First described to be used along with FDBG in dento
maxilary surgeries for sinus lift, to prevent bone
resorption in extraction sockets
• Biological connector betweeen bone graft and recepint
bed.
• Improves angiogenesis , there by granulation tissue
• In alopecia, it is used as intradermal injection along
with hair follicle transplant
• In musculo skeletal injuries, especially tendon injuries,
ultrasound guided injections are found to be useful

19. Contraindications
• coagulopathies and disorders of platelet
function
• anemic and those with thrombocytopenia
• hemodynamic instability,severe hypovolemia,
• unstable angina,
• sepsis
• anticoagulant or fibrinolytic drug therapy

20. Referance
• Platelet-rich Plasma:Properties and Clinical
Applications, RICK G. SMITH,
• Platelet-rich fibrin (PRF): A second-generation
platelet concentrate,David M.
• A Prospective, Randomized, ControlledTrial of
Autologous Platelet-RichPlasma Gel for the
Treatment ofDiabetic Foot Ulcers,Vickie R.
Driver