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Use of platelet-rich plasma and modified nanofat grafting in infected ulcers: Technical refinements to improve regenerative and antimicrobial potential

Archives of Plastic Surgery 2020년 47권 3호 p.217 ~ 222
Segreto Francesco, Marangi Giovanni Francesco, Nobile Carolina, Alessandri-Bonetti Mario, Gregorj Chiara, Cerbone Vincenzo, Gratteri Marco, Caldaria Erika, Tirindelli Maria Cristina, Persichetti Paolo,
소속 상세정보
 ( Segreto Francesco ) - Campus Bio-Medico of Rome University Department of Plastic, Reconstructive and Aesthetic Surgery
 ( Marangi Giovanni Francesco ) - Campus Bio-Medico of Rome University Department of Plastic, Reconstructive and Aesthetic Surgery
 ( Nobile Carolina ) - Campus Bio-Medico of Rome University Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy
 ( Alessandri-Bonetti Mario ) - Campus Bio-Medico of Rome University Department of Plastic, Reconstructive and Aesthetic Surgery
 ( Gregorj Chiara ) - Campus Bio-Medico of Rome University Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy
 ( Cerbone Vincenzo ) - G. Pini Orthopaedic Institute II University Clinic Department of Orthopedics and Traumatology
 ( Gratteri Marco ) - Campus Bio-Medico of Rome University Department of Plastic, Reconstructive and Aesthetic Surgery
 ( Caldaria Erika ) - Campus Bio-Medico of Rome University Department of Plastic, Reconstructive and Aesthetic Surgery
 ( Tirindelli Maria Cristina ) - Campus Bio-Medico of Rome University Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy
 ( Persichetti Paolo ) - Campus Bio-Medico of Rome University Department of Plastic, Reconstructive and Aesthetic Surgery

Abstract


Background: Surgical reconstruction of chronic wounds is often infeasible due to infection, comorbidities, or poor viability of local tissues. The aim of this study was to describe the authors’ technique for improving the regenerative and antimicrobial potential of a combination of modified nanofat and platelet-rich plasma (PRP) in nonhealing infected wounds.

Methods: Fourteen patients met the inclusion criteria. Fat tissue was harvested from the lower abdomen following infiltration of a solution of 1,000 mL of NaCl solution, 225 mg of ropivacaine, and 1 mg of epinephrine. Aspiration was performed using a 3-mm cannula with 1-mm holes. The obtained solution was decanted and mechanically emulsified, but was not filtered. Non-activated leukocyte-rich PRP (naLR-PRP) was added to the solution before injection. Patients underwent three sessions of injection of 8-mL naLR-PRP performed at 2-week intervals.

Results: Thirteen of 14 patients completed the follow-up. Complete healing was achieved in seven patients (53.8%). Four patients (30.8%) showed improvement, with a mean ulcer width reduction of 57.5%±13.8%. Clinical improvements in perilesional skin quality were reported in all patients, with reduced erythema, increased thickness, and increased pliability. An overall wound depth reduction of 76.6%±40.8% was found. Pain was fully alleviated in all patients who underwent re-epithelization. A mean pain reduction of 42%±33.3% (as indicated by visual analog scale score) was found in non-re-epithelized patients at a 3-month follow-up.

Conclusions: The discussed technique facilitated improvement of both the regenerative and the antimicrobial potential of fat grafting. It proved effective in surgically-untreatable infected chronic wounds unresponsive to conventional therapies.

키워드

Platelet-rich plasma; Anti-infective agents; Tissue grafts; Ulcer; Wounds

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