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Tissue Regeneration in Loss of Substance on the Lower Limbs through Use of Platelet-Rich Plasma, Stem Cells from Adipose Tissue, and Hyaluronic Acid

Cervelli, Valerio MD; De Angelis, Barbara MD; Lucarini, Lucilla MD; Spallone, Diana MD; Balzani, Alberto MD; Palla, Ludovico MD; Gentile, Pietro MD; Cerulli, Paolo MD

Advances in Skin & Wound Care: June 2010 - Volume 23 - Issue 6 - pp 262-272
doi: 10.1097/01.ASW.0000363551.82058.36
Features: Original Investigations

BACKGROUND: Platelet-rich plasma (PRP) induces wound regeneration and tissue repair through cell proliferation and differentiation, promoting tissue healing and also acting as an autologous scaffold. With a small quantity of blood, it is possible to obtain the necessary optimal volume of PRP to treat the loss of substance in the lower limb. It has been demonstrated that mesenchymal stem cells are present in the adipose tissue (thus accelerating the effect of the PRP).

METHODS: The analysis involved 30 patients with lesions ranging from ulcerative, dystrophic, with substance loss, with differentiating etiopathogenesis all localized on the inferior limb, and to those treated with PRP and autologous fat grafts. The wounds were covered with a 3-dimensional, polymerized hyaluronic acid medicated biologic dressing. The authors' protocol consists of a general checkup; wound examination; instrumental, microbiological, and immunohistochemical diagnostic examinations; and acquisition of photographic images with follow-up at 0, 1, 2, and 3 weeks; 1, 3, and 6 months; and 1 year.

RESULTS: The results show an improvement from minor to moderate in 100% of patients after 3 weeks, healing in less than 6 weeks in 47% of patients, and complete wound healing in 57% of patients within 3 months.

CONCLUSIONS: The authors' data demonstrate the ability of the combination of PRP and autologous adipose graft to regenerate tissue and epithelialization with wound closure, with a significant healing-time reduction. Furthermore, the minimally invasive technique is well accepted by patients, with a noteworthy improvement of the quality of life along with cost reduction due to the fewer number of medications.

In this study, the authors conclude that their data demonstrate the ability of the combination of platelet-rich plasma and autologous adipose graft to regenerate tissue and epithelialization with wound closure, with a significant healing-time reduction.

Valerio Cervelli, MD, is Director; Barbara De Angelis, MD, is a Physician; Lucilla Lucarini, MD, is a Physician; Diana Spallone, MD, is a Physician; Aberto Balzani, MD, is a Physician; Ludovico Palla, MD, is a Physician; Pietro Gentile, MD, is a Physician; and Paolo Cerulli, MD, is a Physician; all in the Department of Plastic and Reconstructive Surgery, University of "Tor Vergata," Rome, Italy.

Submitted March 23, 2009; accepted in revised form August 31, 2009.

© 2010 Lippincott Williams & Wilkins, Inc.