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Autologous Platelet-Rich Plasma: Guidelines in Plastic Surgery

Gentile, Pietro M.D.; Cervelli, Valerio

Plastic and Reconstructive Surgery: November 2010 - Volume 126 - Issue 5 - p 269e-270e
doi: 10.1097/PRS.0b013e3181ef9518
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University of Tor Vergata; Rome, Italy

Correspondence to Dr. Gentile, University of Tor Vergata, Via L'aquila 7, Rome, Italy 00100

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Sir:

The objectives of this article are to describe the guidelines for the use of platelet-rich plasma in plastic surgery. The authors report exclusion criteria, potential risk associated with the use of platelet-rich plasma, and the methods of preparation.

Platelet-rich plasma can be prepared using Harvest SmartPrep Platelet Concentrate System (Harvest Technologies, Plymouth, Mass.), the 3i Platelet Concentrate Collection System (3i Implant Innovations, Palm Beach Gardens, Fla.; BTI (Biotechnology Institute, Vitoria, Spain), the Vivostat System (Vivolution, Birkerød, Denmark), the Cascade-Esforax System (Cascade Medical Enterprises, Devon, United Kingdom), the RegenPRP-Kit (RegenLab, Mollens-VD, Switzerland), and Plateltex (Bratislava, Slovakia). In all cases in Italy, it is necessary that a medical doctor of the transfusional service is present.

The preparation and processing of platelet-rich plasma is quite similar in most of the platelet-concentrating systems, although the anticoagulant used and the speed and duration of centrifugation may differ with different systems. A recent study by Mazzucco et al.1 evaluated four systems providing platelet-rich plasma with platelet concentration in a range considered clinically effective.

The aim of their study was to evaluate using in vitro analysis the release of platelet-derived factors from platelet-rich plasma gels. Mazzucco et al. concluded that “the methods evaluated in this study were substantially similar.”

Exclusion criteria consisted of the following. The authors have published many articles2,3 regarding the use of platelet-rich plasma in plastic surgery and actually suggested exclusion criteria divided into two types for platelet-rich plasma application: systemic and local. The systemic criteria include platelet disorders, thrombocytopenia, antiaggregating therapy, bone marrow aplasia, uncompensated diabetes, sepsis, and cancer. The local criteria include osteomyelitis and loss of substance of more than 50 percent of the segments treated in the case of chronic or posttraumatic wounds. The authors did not consider tobacco use and genetic disorders to be exclusion criteria.

Sanchez et al.4 have elaborated on the potential risks associated with the use of platelet-rich plasma. The preparation of platelet-rich plasma involves the isolation of platelet-rich plasma, after which gel formation is accelerated using calcium chloride and bovine thrombin. It has been discovered that the use of bovine thrombin may be associated with the development of antibodies to the factors V and XI and thrombin, resulting in the risk of life-threatening coagulopathies. Bovine thrombin preparations have been shown to contain factor V, which could result in stimulation of the immune system when challenged with a foreign protein. Other methods for safer preparation of platelet-rich plasma include the use of recombinant human thrombin, autologous thrombin, or perhaps extrapurified thrombin. Landesberg et al.5 have suggested that alternative methods of activating platelet-rich plasma need to be studied and made available to the dental community. The authors suggest platelet-rich plasma activating with calcium chloride without the use of bovine thrombin associated with the development of antibodies to factors V and XI and thrombin, resulting in a high risk of life-threatening coagulopathies.

Therefore, the commercially available adhesives constitute an infinitely small risk of disease transmission. Platelet-rich plasma is an autologous modification of fibrin glue, which has been described and used in various applications with clinical success. After this description, the new aim of the authors is to apply a single part of growth factors, specifically, platelet-derived growth factor for chronic or posttraumatic wound prevalently, and epidermal growth factor and fibroblast growth factor for skin damage (for burns outcomes).

Pietro Gentile, M.D.

Valerio Cervelli

University of Tor Vergata

Rome, Italy

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REFERENCES

1. Mazzucco L, Balbo V, Cattana E, Guaschino R, Borzini P. Not every PRP-gel is born equal. Evaluation of growth factor availability for tissues through four PRP-gel preparations: Fibrinet, RegenPRP-Kit, Plateltex and one manual procedure. Vox Sang. 2009;97:110–118.
2. Cervelli V, Palla L, Pascali M, De Angelis B, Curcio BC, Gentile P. Autologous platelet-rich plasma mixed with purified fat graft in aesthetic plastic surgery. Aesthetic Plast Surg. 2009;33:716–721.
3. Cervelli V, Gentile P, Scioli MG, Grimaldi M, Spagnoli LG, Orlandi A. Application of platelet-rich plasma to fat grafting during plastic surgical procedures: Clinical and in vitro evaluation. Tissue Eng Part C Methods 2009;15:625–634.
4. Sanchez AR, Sheridan PJ, Kupp LI. Is platelet-rich plasma the perfect enhancement factor? A current review. Int J Oral Maxillofac Implants 2003;18:93–103.
5. Landesberg R, Moses M, Karpatkin M. Risk of using platelet-rich plasma gel. J Oral Maxillofac Surg. 1998;56:1116–1117.

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