Platelet Rich Plasma Treatment Application for Multiple Purposes

Platelet Rich Plasma (PRP) treatments, a relatively new practice, are used for a variety of medical and clinical treatments. More recently, an increasing number of case studies and research has focused on the efficacy and use of PRP to treat injuries, and potential cosmetic benefits. This article is a compilation of numerous case studies regarding diverse uses of PRP in order to better understand the uses as well as efficacy of the treatment. The applications include: atrophic acne scarring, orthopedic care, Hepple stage V osteochondral lesion of the talus, chronic non-healing ulcers, plantar fasciitis, skeletal muscle cell migration, cyclophosphamide-induced hemorrhagic cystitis, and degenerative change of rotator cuff muscles. Introduction/Background: Research provides medicine with novel treatment practices which benefit patient diagnosis, prognosis, and therapy. One such treatment quickly gaining popularity is the use of Platelet Rich Plasma (PRP) injections. These injections can be used to treat many ailments such as long term pain relief and may even affect healing of injuries. The treatment of long term pain is always an important factor to consider. There are many patients who have chronic pain that could be caused by a multitude of reasons. Because of this, there is a constant search for new long term pain relief treatments that may be more effective than current treatment options. PRP injections can benefit many different people. For instance, studies have shown that for sufferers of injuries such as tennis elbow, PRP will outperform local steroids. Also, conditions affected by hypoxia (poor blood supply or low oxygen content) such as tendon and ligament tears; cartilage injuries, bone injuries, and arthritis can be treated with PRP injections. This is due to PRP’s ability to improve blood flow to the hypoxic areas. PRP injections, though gaining popularity quickly, are still not approved by the Federal Drug Administration (FDA) and are surrounded by controversy. This is likely due to the fact the treatment is still not entirely understood and not enough research has been conducted to prove that the treatment is effective. Therefore, even though certain providers offer this treatment as on option, the patient must pay for the treatment entirely out of pocket due to health insurances not covering non FDA approved treatment methods. PRP Injections: PRP injection therapy has been used for over three decades. It has been used in the medical field as a recovery agent after dental, orthopedic, and surgical procedures. Over time its uses have grown due to studies showing the injections could be used for treatment of tendinopathy, chronic tendon and muscle injury, and joint degeneration. PRP is derived from the blood of the patient receiving the treatment. The blood sample taken from the patient is centrifuged to generate a natural concentration of autologous GFs (GFs). Bioactive cytokines and proteins, which are from the platelet’s alpha granules, stimulate chemotaxis, cellular migration, proliferation, differentiation, and extracellular matrix production. The proteins also promote the release of angiogenic GFs, which contribute to tissue regeneration and healing. There are multiple GFs present in PRP. The main GFs are platelet-derived growth factor (PDGF), transforming growth factor β (TGF-β), insulin-like growth factor (IGF-1), and fibroblast growth factor (FGF). The advocates of the treatment believe it works with the body’s ability to heal itself. They claim that use of patient’s organic matter to stimulate the natural healing process of the body should not be unconventional. Also, use of the patient’s own organic matter greatly reduces the rejection rate of the treatment. The critics of the treatment claim that the success stories are results of the placebo effect and see PRP injections as a way to make money. There is the hope that the extended ongoing research of the treatment will help to evaluate its efficacy. Preparation of PRP Injections: PRP’s are synthesized from the patient’s own blood. Therefore, the first step in the process is to extract a small amount of blood from the patient. This is usually around 60 mL. The drawn blood is put through a centrifuge process which separates the platelets from the other cells in the blood. The platelet layer is then extracted from the blood sample in order to be injected into the patient. The extracted platelets are then injected into the location of the injury. After the injection process, GFs are released in the area of the injection resulting in inflammation which lasts for about three days. The next phase is known as the proliferative phase of healing which lasts several weeks. This is followed by the remodeling phase which results in formation and stabilization of the mature tissue and takes around six months. For a few days post injection the patient may experience mild pain and/or irritation surrounding the site of injection. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is discouraged during this time and shouldn’t be used until the patient heals, is pain free, achieves full function, or shows evidence of a plateau in these symptoms. Due to the fact NSAIDs can interfere with the healing process initiated by the injections. The typical number of injections administered in a series is three to five. If there is no improvement after the first or second injection there are usually no further injections. As you can see, the type of injury sustained as well as the patient’s initial reaction to PRP injection treatment will determine the possibility for future injection treatments. PRP Case Study Reviews: Atrophic Acne Scarring: A study published in the Journal of Cosmetic Dermatology observed the effect of PRP injections on atrophic acne scarring. Atrophic acne scarring occurs from abnormal resolution or wound healing after acne inflammation. The study utilized microneedling in combination with PRP in order to reduce acne scarring in a study of 50 individuals. The experiment was conducted by performing microneedling on all patients and on both halves of their faces but by only applying PRP to the right half of the patients face while leaving the left side as the control. Microneedling is a commonly used treatment for acne scarring and employs a thin fine needle to cause minute injury to the dermis stimulating collagen synthesis. Nerve stimulus of the injury, which is transmitted by electrical signals, initiates the healing process. GFs are released causing immediate inflammation to the site of injury. Fibroblasts then migrate to the area stimulating neo-angiogenesis for 8 weeks to 1 year. The study used platelet rich plasma that was prepared by a double-spin method. The double-spin method simply refers to the use of two cycles of centrifugation. The mean platelet count of the final product was 11.73 compared to the base line of 2.26. The platelet count can heavily affect the final result of the treatment The results of the experiment were assessed both by an independent dermatologist as well as by the patients’ satisfaction. The final percentage of improvement for both halves of the face was then taken from mean quantitative scores. The results are shown in the three figures below (Figure 1-3). Figure 1: Overall percentage of improvement in acne scars among both the control and PRP group. Figure 2: Number of patients falling into each category of improvement decided by expert independent dermatologist. 62.20%