Platelet-Rich Plasma for the Treatment of Clean Diabetic Foot Ulcers.

BACKGROUND: Diabetic foot ulcer is considered as a major health problem that predisposes to limb amputation. Among the different methods to achieve ulcer healing, platelet-rich plasma (PRP) gel is gaining popularity. It is thought to stimulate wound closure by providing essential growth factors for healing. This study aims to evaluate the value of autologous PRP gel in the treatment of diabetic ulcers. METHODS: The study included 56 patients of both sex from 18 to 80 years, with clean chronic diabetic foot ulcers divided into 2 equal groups. The first group was treated by antiseptic ointment dressing, and the second group was treated by autologous platelet gel. PRP together with thrombin were prepared by centrifugation at each dressing session. Thrombin and calcium chloride were used to activate the PRP. The formed platelet gel was applied to the wound twice weekly. RESULTS: Statically significant increase in healing rate was found in the PRP-treated group, and complete healing was achieved in 86% of them in comparison to 68% of the control group. In the study group, rate of healing per week was greater during the first 8 weeks and starts to decline afterward. The use of platelet gel showed a lower rate of wound infection. CONCLUSIONS: Autologous platelet gel is more effective than the local antiseptic dressing in terms of healing rate and prevention of infection in clean diabetic ulcers.

Assessment of the Effectiveness of Percutaneous Transluminal Balloon Angioplasty for Failing or Nonmaturing Arteriovenous Fistulae for Hemodialysis.

BACKGROUND: Autologous arteriovenous (A-V) fistulae are the recommended arteriovenous access for long-term dialysis in chronic renal failure patients. However, the rate of nonmaturity and failure is still significant. The present study aimed at salvaging fistulas using percutaneous transluminal balloon angioplasty (PTA). METHODS: Thirty-two patients with nonmaturing or failing fistulas were included, to which they were subjected to PTA with preintervention and postintervention fistulograms to assess the success rate in restoring the fistulae's patency and function. RESULTS: Salvage rate was 26 of 32 fistulas (81.3%) in which the fistulas regain their usability for hemodialysis at least for 3 months of follow-up, 4 cases (12.5%) persist nonmature and 2 cases (6.3%) were not used for stenosis. CONCLUSIONS: PTA is a safe and effective method for treating nonmature and failing native A-V fistulas.