Application of injectable platelet-rich fibrin combined with artificial dermis in treatment of chronic refractory wounds

doi:10.3877/cma.j.issn.1674-0785.2024.10.007

Abstract

Abstract:

Objective

To investigate the efficacy and clinical application value of injectable platelet-rich fibrin (i-PRF) combined with artificial dermis in the treatment of chronic refractory wounds.

Methods

Forty patients admitted to the Department of Burn and Plastic Surgery of Affiliated Hospital of Nantong University from August 2021 to December 2022 were randomly divided into either an artificial dermis alone group or an i-PRF combined with artificial dermis group, with 20 patients in each group.In both groups of patients, the wound was processed until the base tissue was fresh.The artificial dermis alone group underwent artificial dermis transplantation only, and the i-PRF combined combined with artificial dermis group received i-PRF injection derived from autologous blood in the wound and its peripheral tissue, as well as the application of i-PRF injection on the wound surface, followed by artificial dermis transplantation.After regular postoperative dressing changes, for artificial dermis vascular after secondary skin graft repair wound.Wound bacterial colonization, inflammatory indexes, wound pain, time to artificial dermis vascularization,number of dressing changes, hospital stay, and cost were compared between the two groups.

Results

Regarding wound bacterial colonization, there were 13 cases of positive bacterial culture in the artificial dermis alone group and 14 cases in the combination group, with no significant difference in the positive rate of bacterial culture between the two groups (P＞0.05).Seven days after surgery, there were 8 cases of positive bacterial culture in the the artificial dermis alone group, with a negative conversion rate of 38.46%, and 3 cases in the combination group, with a negative conversion rate of 78.57%; the negative conversion rate differed significantly between the two groups (P＜0.05).With regard to inflammation indexes, there was no significant differences in blood leukocytes, C-reactive protein, or procalcitonin between the two groups before surgery(P＞0.05).At 6 d and 12 d after surgery, the time effect was tested in the two groups alone, and the difference was statistically significant (P＜0.05).When the grouping effect was tested separately, the inflammatory indexes of the combination group were lower than those of the artificial dermis alone group, except for those at 12 d after surgery (P＜0.05).For wound pain, the VAS pain scores before surgery and at 1 d after surgery did not differ significantly between the two groups (P＞0.05).At 6 d and 12 d after surgery, the VAS pain scores in both groups decreased, and the VAS pain scores in the combination group were lower than those of the artificial dermis alone group (P＜0.05).The time to vascularization of the artificial dermis,was shorter in the combination group than in the artificial dermis alone group (P＜0.05).The combination group had less dressing changes than the artificial dermis alone group (P＜0.05).The postoperative hospitalization days were fewer and treatment costs were less in the combination group than in the artificial dermis alone group(P＜0.05).

Conclusion

Compared with artificial dermis alone, I-PRF combined with artificial dermis can reduce wound bacterial colonization, control inflammation, relieve wound pain, reduce dressing changes,shorten artificial dermis vascularization and hospital stay, and reduce costs in the treatment of chronic refractory wounds.

Key words: I-PRF, Artificial dermis, Chronic refractory wounds

Hong Ma, Yiqi Chen, Yixin Zhang, Yang Ren, Yuhui Cai, Lei Wang, Xinghua Zhu, Yi Zhang. Application of injectable platelet-rich fibrin combined with artificial dermis in treatment of chronic refractory wounds[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(10): 917-925.

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Figures/Tables 17

项目	人工真皮组	i-PRF联合治疗组	t/χ²值	P值
性别[例（%）]			1.62	0.20
男性	13（65.0）	9（45.0）
女性	7（35.0）	11（55.0）
年龄（岁， $\overset{ˉ}{x}$ ±s）	57.95±12.04	61.00±13.71	-0.75	0.46
创面性质[例（%）]			2.94	0.75
糖尿病溃疡	6（30.0）	7（35.0）
创伤性溃疡	5（25.0）	4（20.0）
烧伤后难愈创面	5（25.0）	2（10.0）
压力性损伤	1（5.0）	3（15.0）
术后伤口不愈	2（10.0）	2（10.0）
静脉性溃疡	1（5.0）	2（10.0）
创面大小（cm²， $\overset{ˉ}{x}$ ±s）	22.93±9.87	20.93±9.77	0.65	0.52
创面存在时间（d， $\overset{ˉ}{x}$ ±s）	64.6±29.38	67.4±33.51	-0.27	0.788
分布位置[例（%）]			0.75	0.82
上肢	5（25.0）	3（15.0）
下肢	12（60.0）	13（65.0）
其他	3（15.0）	4（20.0）

项目	人工真皮组	i-PRF联合治疗组	t/χ²值	P值
性别[例（%）]			1.62	0.20
男性	13（65.0）	9（45.0）
女性	7（35.0）	11（55.0）
年龄（岁， $\overset{ˉ}{x}$ ±s）	57.95±12.04	61.00±13.71	-0.75	0.46
创面性质[例（%）]			2.94	0.75
糖尿病溃疡	6（30.0）	7（35.0）
创伤性溃疡	5（25.0）	4（20.0）
烧伤后难愈创面	5（25.0）	2（10.0）
压力性损伤	1（5.0）	3（15.0）
术后伤口不愈	2（10.0）	2（10.0）
静脉性溃疡	1（5.0）	2（10.0）
创面大小（cm²， $\overset{ˉ}{x}$ ±s）	22.93±9.87	20.93±9.77	0.65	0.52
创面存在时间（d， $\overset{ˉ}{x}$ ±s）	64.6±29.38	67.4±33.51	-0.27	0.788
分布位置[例（%）]			0.75	0.82
上肢	5（25.0）	3（15.0）
下肢	12（60.0）	13（65.0）
其他	3（15.0）	4（20.0）

分组	术前细菌培养阳性	术后7d细菌培养		转阴率（%）
分组	术前细菌培养阳性	阳性	阴性	转阴率（%）
人工真皮组	13	8	5	38.46
i-PRF联合治疗组	14	3	11	78.57
χ²值	-	4.492	-
P值	-	0.034	-

指标	人工真皮组	i-PRF联合治疗组	F值	P值
白细胞（×10⁹/L）
术前	13.1115±5.01741	12.9005±5.11955	0.017	0.896
术后6d	9.4395±2.97526	7.2895±2.47763	6.167	0.018
术后12d	7.333±2.18057	5.644±1.41975	8.427	0.006
C反应蛋白（mg/L）
术前	17.7775±10.69241	18.5085±14.82288	0.032	0.859
术后6d	11.077±5.13989	8.0625±4.08495	4.216	0.047
术后12d	5.2435±2.30399	2.917±2.47775	9.456	0.004
降钙素原（μg/L）
术前	0.213±0.19548	0.234±0.13709	0.155	0.696
术后6d	0.0549±0.05234	0.0215±0.01282	7.661	0.009
术后12d	0.0123±0.00755	0.01±0.00743	0.902	0.348

指标	人工真皮组	i-PRF联合治疗组	F值	P值
术前	4.00±0.8584	4.05±0.99868	0.029	0.866
术后3d	3.10±0.55251	2.50±0.76089	8.143	0.007
术后6d	1.90±0.71818	1.25±0.63867	9.148	0.004
术后9d	1.20±0.76777	0.65±0.67082	5.82	0.021
F值	46.100	66.934	-	-
P值	＜0.001	＜0.001	-	-

组别	例数	人工真皮血管化时间（d）	t值	P值
人工真皮组	20	15.85±1.309	5.895	＜0.001
i-PRF联合治疗组	20	13.60±1.095	5.895	＜0.001

组别	例数	换药次数（次）	t值	P值
人工真皮组	20	8.3±1.62546	3.478	0.0012
i-PRF联合治疗组	20	6.7±1.26074	3.478	0.0012

组别	例数	术后住院时间（d）	t值	P值
人工真皮组	20	27.9±2.33734	5.879	＜0.001
i-PRF联合治疗组	20	23.85±2.00722	5.879	＜0.001

组别	例数	术后费用（元）	t值	P值
人工真皮组	20	30515.25±1832.65257	3.127	0.003
i-PRF联合治疗组	20	28543.7±2142.3014	3.127	0.003

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