ABSTRACT
OBJECTIVE: To investigate the mechanism of autologous platelet-rich gel (APG)in the treatment of refractory diabetic dermal ulcers. METHODS: After the treatment of refractory diabetic dermal ulcers with APG at 0, 3, 6, 9, 15 days, the protein levels of PDGF-BB, VEGF, IGF-1, EGF and TGF-beta1 in the granulation tissue were detected by ELISA, while the dimensions of ulcer area were measured at the same time. RESULTS: The areas of ulcers were obviously reduced at the third and fifteen day after APG treatment (P < 0.05). The concentrations of these 5 growth factors in the granulation tissue were began to increase after 3 days treatment, the peak of PDGF-BB emerged at the third day (P < 0.05), and the peaks of VEGF, IGF-1, TGF-beta1 were found at the ninth day (P < 0.05). The concentration of VEGF increased 2.1-fold, IGF-1 increased 1.95-fold, EGF increased 1.75-fold, PDGF-BB increased 1.89-fold and TGF-beta1 increased 1.67-fold. CONCLUSION: The expression of multiple growth factors are increased in granulation tissue of refractory diabetic dermal ulcers after the treatment of APG,which might be one of the mechanism of APG to treat refractory diabetic dermal ulcer.
Subject(s)
Diabetes Complications/therapy , Gels , Intercellular Signaling Peptides and Proteins/therapeutic use , Platelet-Rich Plasma , Skin Ulcer/therapy , Aged , Becaplermin , Diabetic Foot/therapy , Female , Gels/chemistry , Humans , Insulin-Like Growth Factor I/therapeutic use , Intercellular Signaling Peptides and Proteins/analysis , Male , Middle Aged , Platelet-Derived Growth Factor/therapeutic use , Platelet-Rich Plasma/chemistry , Proto-Oncogene Proteins c-sis , Vascular Endothelial Growth Factor A/therapeutic use , Wound Healing/drug effectsABSTRACT
OBJECTIVE: To assess the effectiveness and security of autologous platelet-rich gel (APG) in the treatment of refractory diabetic dermal ulcers. METHODS: Thirteen diabetic patients with refractory skin lesions were enrolled for this study, and APG was produced by platelet (PLT)-rich plasma (PRP) with thrombin and calcium gluconate. APG treatment consisted of wound dressed with APG, followed by topical washing and cleaning. The APG was then covered with Vaseline gauze and left for 48 to 72 hours, after which the wounds were treated conventionally until the next PLT-gel treatment. The clinical endpoints of the study were the healing rate. RESULTS: A total of 13 patients entered the pilot study. There were no drop-outs in the study. 69.2% ulcers were cured, and especially the ulcer areas were reduced significantly in the first 3 weeks; no adverse reactions were observed. CONCLUSION: Topical therapy with APG may be considered as an effective adjuvant method to treating refractory diabetic dermal ulcer.