Background Chronic leg ulcers are those with no tendency to heal after 3 months of appropriate treatment or not fully healed at 12 months.Around 2-7% of leg ulcers are due to vasculitis.Good standard wound care doesn't always provide improved healing and often more advanced therapies are employed.Wound healing is a complex and dynamic process posing a great diagnostic and therapeutic challenge.Platelet rich plasma (PRP) induces molecular and cellular mechanisms of wound healing by upregulation of cell cycle regulatory proteins (Cyclin A & CDK4) and release of various growth factors.
Objectives To determine the role and efficacy of PRP in the healing of recalcitrant vasculitic ulcers and to study rapidity of healing with respect to site of ulcer, platelet concentration in the prepared PRP and underlying Rheumatological condition
Methods Institutional Ethical board clearance was obtained.Consent was obtained from patients.A Randomized Prospective Interventional study was conducted on 40 patients attending rheumatology outpatient department with chronic non healing vasculitic ulcers of more than 3 months duration,which were resistant to steroids and immunosuppresants, after investigating for primary Rheumatological disease activity & investigations pertaining to the ulcer with platelet analysis.Patients with Coagulation disorders/on drugs affecting coagulation profile were excluded from the study.Autologous PRP was prepared in our Rheumatology lab by centrifugation followed by which platelet activation was done.This PRP was applied over the ulcer and occlusive dressing was done.Ulcer severity and response was followed up weekly using Leg Ulcer Measurement Tool (LUMT) until satisfactory healing was obtained.
Results We observed that PRP application lead to faster and successful closure of all ulcers with an average of 5.4 weeks, during 6 months follow up.The healing duration was proportional to the average fold increase in the platelet concentration in the prepared PRP.There were no complications observed with the treatment.There was no recurrence of the ulcer at the same site during the 6 month follow-up period.
Conclusions Hence, we conclude that,application of PRP has a quicker induction of granulation tissue,faster healing of the ulcers and the recurrence rate was low.PRP application is a simple, safe and cost effective day care procedure for treating chronic non-healing vasculitic ulcers which requires an optimal set-up and expertise.
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Disclosure of Interest None declared
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