As we have learned, uncontrolled diabetes has many complications. Complications include having decreased sensation in the limbs and a decreased blood supply (ischaemia) to the limbs. Diabetic patients with ischaemic foot ulcers have the worst outcome of all chronic skin wounds.
Surgery to heal diabetic ulcers can include tenotomy, tendon lengthening, reconstruction surgery, or removal of bony prominences of the foot, but these procedures may result in a secondary ulceration. Also, along with secondary ulceration, some other complications may also arise. The recurrence rate for diabetic ulcers is also very high.
In recent years, to combat these issues, medical science has introduced topical gels containing growth factors that is proving to be a successful form of treatment for diabetic ulcers. Platelet rich plasma (PRP) gel is an efficacious treatment of chronic diabetic foot ulceration. It represents similarity to the natural healing process as a composite of multiple growth factors. It is safe due to its autologous nature (derived from same person).
Growth factors are proteins that play an important role in wound healing. Without functional growth factors, an ulcer can get stuck in a non-healing phase and will be very difficult to heal on it’s own.
There have been many studies conducted on the efficacy and safety of using platelet rich plasma over the years to treat diabetic foot ulcers, and most of them have concluded that the patients had complete healing. The procedure is safe and there are no serious adverse effects of this therapy.
If diabetic foot ulcers are left untreated or treated inappropriately or treated late, gangrene (death of the tissue) may result and you may have to sacrifice your limb. PRP gel therapy provides ulcer management option to avoid loss of limb. When used with good standards of care, the majority of non healing diabetic foot ulcers treated with autologous platelet-rich plasma gel are expected to heal.
Platelets contain a large numbers of different types of growth factors. When applied topically on the ulcer, this preparation promotes rapid vascularization of the healing tissue and, because it is autologous, it eliminates concerns about immunogenic reactions and disease transmission.
Approximately ≤ 20 ml of blood is collected from the patient depending on the size of the ulcer and is placed in a centrifuge for 15 minutes. A centrifuge spins the blood to separate the platelets. The platelet concentrate is then mixed with a reagent (thrombin) to create a gel-like substance which is applied directly to the wound. Gel consistency is usually attained within 15 to 30 seconds after mixing with the reagent. A contact layer dressing will then be applied over the gel. A foam dressing is then placed over the contact dressing so that PRP gel is not absorbed. To protect it from slipping out, a barrier cream is generally placed on the intact skin surrounding the wound.
There is no fear of infection or immunologic reactions. The results are generally evident in as little as 5 weeks if given twice weekly.
Each visit, the wound is cleaned and assessed for improvement. Several studies have shown that withdrawal of small amount of blood twice weekly does not affect patient’s hemoglobin levels.
Foot ulcers are an expensive problem. A healed ulcer greatly improves the poor quality of life caused by a foot ulcer, whereas a non healing ulcer reduces the quality of life for both patients and his/her caregiver. Cost of amputation is high which involves the surgery cost and cost of hospitalization stay. In addition, the patient has to take off from work and this contributes to loss of pay. All coupled together, this is a significant cost to the patient. PRP therapy, on the other hand, can be applied in an outpatient or clinic medical setting which represents cost effectiveness for patients. Several studies have concluded the use of PRP gel results in improved quality of life and lowered cost of care as compared to other treatment modalities for nonhealing diabetic foot ulcers. PRP is not a expensive technique and has rapid healing capacity. Currently there is no insurance cover, but the cost of treating a patient with PRP is significantly lower.