The Role of Topical Autologous Plasma Rich Membranes in Healing Diabetic Foot Ulcers Editorial Summary This article provides a short and concise overview of bedside treatment of Diabetic Foot Ulcers (DFUs) using an Autologous Plasma Rich in Growth Factors Membrane in clinical practice.
Introduction
among others.
D
iabetic Foot Ulcers (DFUs) are common and are a major source of disability, distress, and cost. DFUs are difficult to heal because of poor vascularity and impaired sensation resulting from sensory neuropathy. There are around 7,000 lower limb amputations in diabetes patients in England each year, and the likelihood that someone with diabetes will have a leg, foot or toe amputation is around 23 times that of a person without diabetes.
Why Use Autologous Membranes?
Plasma
Rich
In recent years there is great interest in the use of autologous platelet rich products for use in DFUs. Topical growth factor products are typically used as adjuvant treatments along with the standard care for treatment of diabetic foot ulceration with successful results. Endoret® PRGF® (Plasma Rich Growth Factors) uses advanced biomedical technology to stimulate tissue regeneration with the use of autologous proteins found in the blood. The Endoret® PRGF® technique involves a simple bedside procedure to obtain a platelet concentrated fibrin membrane rich in autologous growth factors, which acts as a biological membrane. Endoret® PRGF® preparation was shown to have higher levels of most growth factors which help in biological wound healing. This preparation has demonstrated its effectiveness in multiple medical fields including dentistry, oral implantology, opthalmology and orthopedics,
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Wound Masterclass - Vol 1 - June 2022
To improve wound healing and to accelerate the epithelization of chronic wounds, we applied the Endoret® technique on diabetic patients with chronic, non-healing DFUs to test PRGF clot membrane therapy. The Endoret® technique consists of a single treatment. Venous blood was obtained and collected using the Endoret® PRGF® protocol in 9ml sterile tubes containing 3.8% (wt/v) Sodium Citrate (SC). Using Endoret® patented technology, the blood was centrifuged for 8 minutes at room temperature using the Endoret® PRGF® system centrifuge to obtain PRGF. The PRGF was drawn off in 2 fractions, labelled F1 and F2. F1 was injected around the wound margins. Two millilitres of F2, which contains the optimal concentration of platelets (2-3x) isolated above the erythrocytes and leucocytes, was drawn up using the Plasma Transfer Device (PTD). F2 was then activated using Calcium Chloride (CC). Upon completion of the Endoret® protocol, a fibrin clot was formed and placed over the bed of the ulcer, and the remaining F2 was infiltrated around the edges of the wound. Adequate dressing was secured, and the patient kept non-weight-bearing. Subsequent follow-ups were done in the clinic at 2 weekly intervals for examination of the wound, dressing and medical photography by a trained nurse. In all cases, the entire procedure took under 1 hour. Patients were followed up until the end point was achieved, which was defined as full epithelization of ulcer without drainage.
Prof Anand Pillai Consultant Orthopaedic Foot & Ankle and Adult Reconstruction Surgeon Manchester, United Kingdom
Mr Noman Niazi Manchester University Hospitals NHS Foundation Trust Manchester, United Kingdom