Journal Logo

Research Article: Study Protocol Systematic Review

Efficacy of autologous platelet-rich plasma in treating patients with burn wounds

A protocol for systematic review and meta-analysis

Wu, Yan-Hong MD; Zhang, Li-Ming MD; Wang, Yu-Zhi MD; Chen, Jian-Wu MD; Zhang, Bin MD; Tang, Jian-Bing MD; Cheng, Biao MD

Author Information
doi: 10.1097/MD.0000000000025650
  • Open

Abstract

1 Introduction

Burns are among the severe public health problems, with significantly higher morbidity and mortality levels.[1–3] Burn wounds resulting from burns can be traumatic and challenging to manage, primarily owing to the complications arising from the initial skin loss, including pain and itching.[4] Besides, hypertrophic scars induced by burns can cause physical and psychological trauma to patients, reducing their self-esteem and affecting their quality of life.[5] In particular, the treatment of burns consumes large amounts of medical resources, causing a significant economic burden to society.[2,6] following effectual and appropriate treatment, several patients can enjoy a quality life. To this end, burn treatment aims to ascertain effectual wound management, which mainly establishes patients’ wound survival and prognosis after experiencing severe burns.[7,8] Different healing drugs, such as DNA, siRNA, growth factors, and stem cell therapy, are considered to stimulate burn wound restoration.[9–13] Finding a suitable dressing for the burn wound is a significant challenge. While achieving the primary goal of wound healing, reducing the cost of burn treatment is also a critical goal to consider.

Platelet-rich plasma (PRP) denotes a plasma fraction of autologous blood with an above-the-baseline platelet concentration.[14] PRP has been primarily applied in spine, plastic surgery, diabetic foot ulcers, as well as wound care. Accordingly, its use has not been associated with adverse reactions.[15–17] Recent advances in PRP in humans have indicated that PRP in burns is an area of research interest. However, there are many controversies regarding the application of autologous PRP. The present study's overall aim will be to summarise the available proofs in assessing the efficacy and safety of autologous PRP to treat patients who have burn wounds.

2 Methods

According to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) statement guidelines, the protocol will be reported in the present study.[18] Moreover, this protocol has been registered on the Open Science Framework (OSF, http://osf.io/).

2.1 Eligibility criteria

2.1.1 Types of studies

Only randomised controlled trials (RCTs) assessing autologous PRP's efficacy and safety to treat patients with burn wounds will be included.

2.1.2 Types of participants

Participants diagnosed with burn, including different sites and depths of burn.

2.1.3 Types of interventions and comparisons

We intend to include RCTs comparing local injections or dressed with autologous PRP with no intervention, silver sulfadiazine, saline, placebo dressings, or other wound dressings.

2.1.4 Types of outcome measures

The significant outcomes will include the high number of patients whose wounds heal totally. The minor outcomes were time to complete wound healing, reactions related to allergies, loss of graft, experiencing wound pain, quality or nature of scar, and adverse events.

2.2 Search methods for primary studies

2.2.1 Electronic searches

We will conduct a systematic search using MEDLINE, EMBASE, the Cochrane Library, Web of Science, CINAHL, and Scopus to detect randomised controlled trials (RCTs) that the assessment of effectiveness and safety of autologous PRP in treatment of burn wounds from their inception to March 2021 with no language restrictions. The study will implement these search phrases: “autologous platelet-rich plasma” OR “platelet-rich plasma” OR “platelet-rich” OR “platelet plasma” OR “platelet gel” paired with “burns” OR “burn.”

2.2.2 Searching other sources

Also, we will search Google Scholar, ClinicalTrials.gov, with the identity possibly eligible.

2.3 Data collection and analysis

2.3.1 Selection of studies

Two independent reviewers will be employed to screen the literature. They will delete duplicated and non-RCTs studies by screening titles and abstracts of the retrieved articles for suitability for RCTs. Second, the reviewers will be tasked with assessing the full texts to obtain eligible papers. Finally, we plan to address any disagreements emanating from this process through discussion. Moreover, a third author will mediate situations of misunderstandings. The selection process will be shown in Figure 1.

F1
Figure 1:
Flow diagram of study selection.

2.3.2 Data extraction

We will use two independent reviewers to extract data from specifically included studies by means of a data extraction sheet. We will consider extracted information to contain publication details, study eligibility criteria, study details, participant characteristics, description of intervention and comparison, and outcome indicators. Moreover, we intend to address or any disagreements through discussion. A third author will mediate situations of disagreement.

2.3.3 Risk of bias assessment

We will use two independent reviewers to evaluate the risk of bias in the RCTs utilizing the Cochrane Collaboration's Risk of Bias Tool 2.0. In case of any disagreements, we will address them through discussion. A third author will mediate situations of disagreement. The reviewers will review and score each of the records as ‘high’, ‘low’, or ‘unclear’ risks of bias depending on the following domains: ‘random sequence generation and allocation concealment’ (selection bias), ‘participant and personnel blinding’ (performance bias), ‘incomplete outcome data’ (attrition bias), ‘blinding for outcome assessments’ (detection bias), ‘selective outcome reporting’ (reporting bias), among others.

2.3.4 Measures of treatment effect

The study will express the dichotomous data as the ‘relative risk’ (RR) and 95% ‘confidence intervals’ (CIs). It will also express continuous data as the ‘mean difference’ (MD) or ‘standardised mean difference’ (SMD) together with 95% CI.

2.3.5 Management of missing data

In scenarios where of missing data, we intend to communicate with the corresponding author to obtain such missing data. Failure to recover sufficient data can impel us to examine studies with missing data and report the reasons for such scenarios.

2.3.6 Assessment of heterogeneity

We plan to evaluate statistical heterogeneity by the I2 statistic. Furthermore, we plan to regard a level of heterogeneity of more than 50% as substantial heterogeneity. We will pool data by means of the random-effects model.

2.3.7 Sensitivity analysis

By identifying sufficient studies, we intend to carry out sensitivity analysis using appropriate methods to evaluate the results’ reliability.

3 Discussion

Over the years, utilization of PRP has attracted widespread use in patients with burn wounds. However, the efficacy and safety of autologous PRP in treating patients with burn wounds are still inconclusive. Therefore, the present study seeks to evaluate autologous PRP's effectiveness and safety in burn wounds patients. We anticipate that these findings will provide clinicians with the basis for autologous PRP of burn wounds and provide optimal patient treatment choice.

Author contributions

Conceptualization: Yan-Hong Wu, Yu-Zhi Wang.

Data curation: Yan-Hong Wu, Li-Ming Zhang, Yu-Zhi Wang.

Formal analysis: Yan-Hong Wu, Jian-Wu Chen, Biao Cheng.

Funding acquisition: Yan-Hong Wu, Li-Ming Zhang, Jian-Wu Chen, Bin Zhang, Jian-Bing Tang.

Investigation: Yan-Hong Wu, Bin Zhang.

Methodology: Yu-Zhi Wang, Bin Zhang.

Project administration: Yu-Zhi Wang.

Resources: Li-Ming Zhang, Jian-Wu Chen, Bin Zhang, Jian-Bing Tang, Biao Cheng.

Software: Li-Ming Zhang, Yu-Zhi Wang.

Validation: Yan-Hong Wu, Li-Ming Zhang, Jian-Wu Chen, Bin Zhang, Jian-Bing Tang, Biao Cheng.

Visualization: Yu-Zhi Wang, Jian-Wu Chen, Biao Cheng.

Writing – original draft: Yan-Hong Wu.

Writing – review & editing: Yan-Hong Wu.

References

[1]. Brusselaers N, Monstrey S, Vogelaers D, et al. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Crit Care 2010;14:R188.
[2]. Yang C, Xu XM, He GZ. Efficacy and feasibility of opioids for burn analgesia: an evidence-based qualitative review of randomised controlled trials. Burns 2018;44:241–8.
[3]. Jiang Q, Chen ZH, Wang SB, et al. Comparative effectiveness of different wound dressings for patients with partial-thickness burns: study protocol of a systematic review and a Bayesian framework network meta-analysis. BMJ Open 2017;7:e013289.
[4]. Mostaque AK, Rahman KB. Comparisons of the effects of biological membrane (amnion) and silver sulfadiazine in the management of burn wounds in children. J Burn Care Res 2011;32:200–9.
[5]. Mohammadi AA, Eskandari S, Johari HG, et al. Using amniotic membrane as a novel method to Reduce post-burn hypertrophic scar formation: a prospective follow-up study. J Cutan Aesthet Surg 2017;10:13–7.
[6]. Mohammadi AA, Seyed Jafari SM, Kiasat M, et al. Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods. Burns 2013;39:349–53.
[7]. Rowan MP, Cancio LC, Elster EA, et al. Burn wound healing and treatment: review and advancements. Crit Care 2015;19:243.
[8]. Cancio LC. Topical antimicrobial agents for burn wound care: history and current status. Surg Infect (Larchmt) 2021;22:03–11.
[9]. Guo R, Xu S, Ma L, et al. The healing of full-thickness burns treated by using plasmid DNA encoding VEGF-165 activated collagen-chitosan dermal equivalents. Biomaterials 2011;32:1019–31.
[10]. Castleberry SA, Golberg A, Sharkh MA, et al. Nanolayered siRNA delivery platforms for local silencing of CTGF reduce cutaneous scar contraction in third-degree burns. Biomaterials 2016;95:22–34.
[11]. Barrientos S, Brem H, Stojadinovic O, et al. Clinical application of growth factors and cytokines in wound healing. Wound Repair Regen 2014;22:569–78.
[12]. Hoeferlin LA, Huynh QK, Mietla JA, et al. The lipid portion of activated platelet-rich plasma significantly contributes to its wound healing properties. Adv Wound Care (New Rochelle) 2015;4:100–9.
[13]. Amini-Nik S, Dolp R, Eylert G, et al. Stem cells derived from burned skin—-the future of burn care. EBioMed 2018;37:509–20.
[14]. Marx RE, Armentano L, Olavarria A. Samaniego J. rhBMP-2/ACS grafts versus autogenous cancellous marrow grafts in large vertical defects of the maxilla: an unsponsored randomised open-label clinical trial. Int J Oral Maxillofac Implants 2013;28:e243–51.
[15]. Bose B, Balzarini MA. Bone graft gel: autologous growth factors used with autograft bone for lumbar spine fusions. Adv Ther 2002;19:170–5.
[16]. Dai J, Jiang C, Sun Y, et al. Autologous platelet-rich plasma treatment for patients with diabetic foot ulcers: a meta-analysis of randomised studies. J Diabetes Complications 2020;34:107611.
[17]. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004;62:489–96.
[18]. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:01.
Keywords:

autologous platelet-rich plasma; burns; systematic review; wound healing

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.