Evidence on the use of platelet-rich plasma for diabetic ulcer: a systematic review.

The aim of topical wound treatment is to favor efficient, rapid, and safe healing. The platelet-rich plasma (PRP) has been used for wound treatment since it contains various platelet growth factors. The objective of the present study was to collect evidence regarding the use of PRP for the topical treatment of chronic leg ulcers. For this purpose, a systematic review of the literature was performed according to the steps recommended by the Cochrane Collaboration with studies published until July 2008. Among 18 selected studies, 7 (39%) of these studies were randomized clinical. Five of the seven randomized clinical trials studied ulcers of diabetic etiology. The results of meta-analysis showed that PRP favors the healing process (95% CI: 2.94-20.31). In conclusion, the present systematic review and meta-analysis show that there is a scientific evidence regarding favorable outcomes of the use of PRP for the treatment of diabetic ulcer.

Terapia tópica de úlceras crônicas de perna com plasma rico em plaquetas - PRP: revisão sistemática da literatura / The tropical treatment on leg chronic ulcer with platelet rich plasma: a systematic review

O tratamento tópico de feridas visa favorecer um processo de cicatrização eficaz, rápido e seguro. Como uma das opções, o Plasma Rico em Plaquetas – PRP - um concentrado de plaquetas obtido por meio de centrifugação sanguínea ou aférese, vem sendo também utilizado no tratamento de feridas por conter os fatores de crescimento plaquetários. Visto que se trata de uma terapia inovadora, este estudo objetivou buscar as evidências sobre o seu uso na terapia tópica de feridas crônicas de perna. Para tanto, realizou-se revisão sistemática de literatura, seguindo-se as etapas preconizadas pela Colaboração Cochrane. Os estudos foram levantados até 2006, por meio dos descritores platelet rich plasma, platelet derived growth factor, platelet gel, platelet releasate, platelet lysate, CT-102 activated supernatant, wound healing, chronic wound, foot ulcer, diabetic foot, e varicose ulcer, utilizando diferentes combinações, conforme a base de dados consultada (Cochrane, PubMed, Lilacs, Embase e Cinahal). Para a análise da validade interna dos estudos, empregaram-se: a Escala de Jadad, Escala de Avaliação do Grau de Recomendação e Evidência e Escala de Avaliação do Controle das Variáveis. De 56 estudos pré-selecionados, chegou-se à amostra de 18 ensaios clínicos, indexados, principalmente, no PubMed/ Medline (17 / 94,5%), originários dos EUA (12 / 66,6%) e publicados em língua inglesa. Desses, sete (39%) eram ensaios clínicos randomizados, que obtiveram forte recomendação (A) e nívelde evidência alto. A partir das metanálises desses ensaios randomizados, em diferentes combinações, os resultados mostraram que o PRP favorece o processo de cicatrização (IC95% 1,84 - 7,41), principalmente em úlceras diabéticas (IC95% 2,94 - 20,31), e quando utilizado como CT-102 (IC95% 2,70-41,40). Concluindo, esta revisão sistemática e metanálise mostram que há evidências científicas sobre os ) resultados favoráveis do uso do PRP em feridas crônicas de perna, principalmente as de etiologia diabética.

The wound topical treatment stimulates an effective, fast and safe wound healing. The platelet rich plasma (PRP) – a concentrated of platelets obtained from centrifugation or single apheresis, has been used as the treatment of wounds because it contains platelet derived growth factor. Being a new therapy, the aim of this study is to show some evidence about the effectiveness of PRP on the healing of chronic wound leg. To this test, a systematic review was conducted, as the recommendation of the Cochrane Library. The studies were screened until 2006 using some key words: platelet rich plasma, platelet derived growth factor, platelet gel, platelet releasate, platelet lysate, CT-102 activated supernatant, wound healing, chronic wound, foot ulcer, diabetic foot, and varicose ulcer; with different combinations, according to data base (Cochrane, PubMed, Lilacs, Embase e Cinahal). From 56 studies, 18 were clinical trials, specially found in PubMed (17 / 94,5%), originated in USA (12 / 66,6%) and published in English. Seven (39%) were clinical trials randomized , classified as a strong recommendation (A) with high evidence level. The meta-analysis of these randomized trials, shows the PRP promotion in wound healing (CI 95% 1,84-7,41), mainly in diabetic ulcer (CI 95% 2,70-41,40). To sum up, this study provides a scientific evidence on repair of chronic wound leg, mainly diabetic ulcer, using PRP.