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Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review
AIM: To determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates. METHODS: A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV investigations of topical PRP application in DFUs were...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198285/ https://www.ncbi.nlm.nih.gov/pubmed/30364787 http://dx.doi.org/10.4239/wjd.v9.i10.172 |
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author | Hirase, Takashi Ruff, Eric Surani, Salim Ratnani, Iqbal |
author_facet | Hirase, Takashi Ruff, Eric Surani, Salim Ratnani, Iqbal |
author_sort | Hirase, Takashi |
collection | PubMed |
description | AIM: To determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates. METHODS: A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV investigations of topical PRP application in DFUs were sought in multiple databases including: MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The search terms used were “platelet rich plasma”, “diabetes”, “ulcers”, and “wound”. The Modified Coleman Methodology Score (MCMS) was used to analyze study methodological quality. Study heterogeneity and a mostly non-comparative nature of evidence precluded meta-analysis. Only the outcome measurements used by more than 50% of the studies were included in the data synthesis to increase power of the measurement over that of individual studies. A weighted mean of healing rate per week between PRP group vs controls were compared using two-sample z-tests using P-value of less than 0.05 for significance. RESULTS: One thousand two hundred and seventeen articles were screened. Eleven articles (322 PRP subjects, 126 controls, PRP subject mean age 58.4 ± 7.2 years, control mean age 58.7 ± 5.9 years) were analyzed. Six articles were level II evidence, four were level III, and one article was level IV. The mean MCMS was 61.8 ± 7.3. Healing rate was significantly faster with PRP application compared to controls (0.68 ± 0.56 cm(2)/wk vs 0.39 ± 0.09 cm(2)/wk; P < 0.001). Mean heal time to > 90% of the original ulcer area was 7.8 ± 2.7 wk and 8.3 ± 3.7 wk for patients in the PRP group and control groups, respectively (P = 0.115). There were significantly lower adverse effects reported with PRP application compared to controls (7 wound infections, 1 contact dermatitis vs 14 wound infections, 1 maceration; P < 0.001). CONCLUSION: The topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls. |
format | Online Article Text |
id | pubmed-6198285 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-61982852018-10-24 Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review Hirase, Takashi Ruff, Eric Surani, Salim Ratnani, Iqbal World J Diabetes Systematic Reviews AIM: To determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates. METHODS: A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV investigations of topical PRP application in DFUs were sought in multiple databases including: MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The search terms used were “platelet rich plasma”, “diabetes”, “ulcers”, and “wound”. The Modified Coleman Methodology Score (MCMS) was used to analyze study methodological quality. Study heterogeneity and a mostly non-comparative nature of evidence precluded meta-analysis. Only the outcome measurements used by more than 50% of the studies were included in the data synthesis to increase power of the measurement over that of individual studies. A weighted mean of healing rate per week between PRP group vs controls were compared using two-sample z-tests using P-value of less than 0.05 for significance. RESULTS: One thousand two hundred and seventeen articles were screened. Eleven articles (322 PRP subjects, 126 controls, PRP subject mean age 58.4 ± 7.2 years, control mean age 58.7 ± 5.9 years) were analyzed. Six articles were level II evidence, four were level III, and one article was level IV. The mean MCMS was 61.8 ± 7.3. Healing rate was significantly faster with PRP application compared to controls (0.68 ± 0.56 cm(2)/wk vs 0.39 ± 0.09 cm(2)/wk; P < 0.001). Mean heal time to > 90% of the original ulcer area was 7.8 ± 2.7 wk and 8.3 ± 3.7 wk for patients in the PRP group and control groups, respectively (P = 0.115). There were significantly lower adverse effects reported with PRP application compared to controls (7 wound infections, 1 contact dermatitis vs 14 wound infections, 1 maceration; P < 0.001). CONCLUSION: The topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls. Baishideng Publishing Group Inc 2018-10-15 2018-10-15 /pmc/articles/PMC6198285/ /pubmed/30364787 http://dx.doi.org/10.4239/wjd.v9.i10.172 Text en ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Systematic Reviews Hirase, Takashi Ruff, Eric Surani, Salim Ratnani, Iqbal Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review |
title | Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review |
title_full | Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review |
title_fullStr | Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review |
title_full_unstemmed | Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review |
title_short | Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review |
title_sort | topical application of platelet-rich plasma for diabetic foot ulcers: a systematic review |
topic | Systematic Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198285/ https://www.ncbi.nlm.nih.gov/pubmed/30364787 http://dx.doi.org/10.4239/wjd.v9.i10.172 |
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