Hirase T, Ruff E, Surani S, Ratnani I, et al.
World journal of diabetes. Date of publication 2018 Oct 15;volume 9(10):172-179.
1. World J Diabetes. 2018 Oct 15;9(10):172-179. doi: 10.4239/wjd.v9.i10.172.
Topical application of platelet-rich plasma for diabetic foot ulcers: A
systematic review.
Hirase T(1), Ruff E(2), Surani S(3), Ratnani I(4).
Author information:
(1)Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX
77030, United States.
(2)Department of Plastic and Reconstructive Surgery, University of Texas Medical
Branch, Galveston, TX 77555, United States.
(3)Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Texas A
and M University, Corpus Christi, TX 77807, United States. srsurani@hotmail.com.
(4)Department of Anesthesiology and Critical Care, Houston Methodist Hospital,
Houston, TX 77030, United States.
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 cm2/wk vs 0.39 ± 0.09 cm2/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.
DOI: 10.4239/wjd.v9.i10.172
PMCID: PMC6198285
PMID: 30364787
Conflict of interest statement: Conflict-of-interest statement: All the authors
declare that they have no competing interests.
