KMID : 1038220200470030217
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Archives of Plastic Surgery 2020 Volume.47 No. 3 p.217 ~ p.222
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Use of platelet-rich plasma and modified nanofat grafting in infected ulcers: Technical refinements to improve regenerative and antimicrobial potential
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Segreto Francesco
Marangi Giovanni Francesco Nobile Carolina Alessandri-Bonetti Mario Gregorj Chiara Cerbone Vincenzo Gratteri Marco Caldaria Erika Tirindelli Maria Cristina Persichetti Paolo
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Abstract
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Background: Surgical reconstruction of chronic wounds is often infeasible due to infection, comorbidities, or poor viability of local tissues. The aim of this study was to describe the authors¡¯ technique for improving the regenerative and antimicrobial potential of a combination of modified nanofat and platelet-rich plasma (PRP) in nonhealing infected wounds.
Methods: Fourteen patients met the inclusion criteria. Fat tissue was harvested from the lower abdomen following infiltration of a solution of 1,000 mL of NaCl solution, 225 mg of ropivacaine, and 1 mg of epinephrine. Aspiration was performed using a 3-mm cannula with 1-mm holes. The obtained solution was decanted and mechanically emulsified, but was not filtered. Non-activated leukocyte-rich PRP (naLR-PRP) was added to the solution before injection. Patients underwent three sessions of injection of 8-mL naLR-PRP performed at 2-week intervals.
Results: Thirteen of 14 patients completed the follow-up. Complete healing was achieved in seven patients (53.8%). Four patients (30.8%) showed improvement, with a mean ulcer width reduction of 57.5%¡¾13.8%. Clinical improvements in perilesional skin quality were reported in all patients, with reduced erythema, increased thickness, and increased pliability. An overall wound depth reduction of 76.6%¡¾40.8% was found. Pain was fully alleviated in all patients who underwent re-epithelization. A mean pain reduction of 42%¡¾33.3% (as indicated by visual analog scale score) was found in non-re-epithelized patients at a 3-month follow-up.
Conclusions: The discussed technique facilitated improvement of both the regenerative and the antimicrobial potential of fat grafting. It proved effective in surgically-untreatable infected chronic wounds unresponsive to conventional therapies.
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KEYWORD
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Platelet-rich plasma, Anti-infective agents, Tissue grafts, Ulcer, Wounds
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