AB0663 Role and Efficacy of Autologous Platelet Rich Plasma in Chronic Resistant Non Healing Vasculitic Ulcers
Authors: S. Sriram
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> 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 doesn9t 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 &amp; CDK4) and release of various growth factors. <h3>Objectives</h3> 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 <h3>Methods</h3> 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 &amp; 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. <h3>Results</h3> 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. <h3>Conclusions</h3> 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. <h3>References</h3> Braund R, Hook S, Medlicott NJ. The role of topical growth factors in chronic wounds. Curr Drug Deliv 2007;4:195-204. Yuan T, Zhang CQ, Tang MJ, Guo SC, Zeng BF. Autologous platelet rich plasma enhances wound healing in chronic wounds. Wounds 2009;21:280-5 McRorie ER, Jobanputra P, Ruckley CV, Nuki G. Leg ulceration in rheumatoid arthritis. Br J Rheumatol 1994; 33: 1078–84 Knighton DR, Ciresi KF, Fiegel VD, Austin LL, Butler EL. Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF). Ann Surg 1986;204:322-30 Kakudo N, Kushida S, Ogura N, Hara T, Suzuki K. The use of autologous platelet rich plasma in the treatment of intractable skin ulcer. Open J Reg Med 2012;1:29-32 <h3>Disclosure of Interest</h3> None declared