Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury
Introduction
Despite advances in surgical techniques and pharmacology, healing of injury-associated soft tissue defects is frequently complicated by infections, which often requires a secondary intervention. Secondary operations to promote healing processes of the wound are associated with high rates of patient morbidity and reduced quality of life [1]. Fractures with an open wound, soft tissue loss, severe comminution and bone loss or displacement are more prone to infectious complications resulting in nonhealing wound and nonunion [1], [2].
Cytokines are important mediators of healing processes. Application of platelet-rich gel, known also as autologous platelet–leukocyte rich gel (PLRG) [3], represents a novel approach to the treatment of soft tissue and bone healing disturbances [2], [3]. Upon platelet activation, platelet α-granules release over 30 cytokines including platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), epidermal growth factor (EGF) [3] and also antimicrobial proteins [4]. Here, we present a case report exemplifying a potential benefit of PLRG for healing of an infected high-energy injury-associated wound.
Section snippets
Case report
A 42-year-old man experienced femoral and crural fracture with large skin defect after accident in a coalmine. This was associated with an injury of popliteal vessels, so the transplantation of a vein from undamaged leg was necessary to restore the arterial blood circulation. Since the venous circulation system was insufficient, the patient underwent fasciotomy. With the symptoms of respiratory and circulatory failure the patient was transferred to Intensive Care Unit. Mechanical ventilation
Discussion
Wound healing is a multi-step biological process that begins with trauma and ends with scar formation [1]. Directly after injury, hemostasis is achieved with platelet clot formation. This is associated with an abundant release of growth factors from platelet α-granules such as PDGF, TGF-β, VEGF, IGF, EGF and many others [3]. Inflammatory cells kill microbes, and prevent the colonization of the wound. If inflammation is delayed or stopped, the wound becomes susceptible to infection and closure
Acknowledgements
We gratefully acknowledge the assistance of Dr. Allan Mishra and Matthew Swift in the preparation of this manuscript. This work was supported by Committee for Scientific Research – Polish Ministry of Science No. N403 070 32/4120. Director of Grant: Agata Cieslik-Bielecka, M.D, Ph.D.
References (13)
- et al.
Improved treatment of mandibular odontogenic cysts with platelet-rich gel
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
(2008) - et al.
Treatment of chronic femoral osteomyelitis with platelet-rich plasma (PRP): a case report
Transfus Apher Sci
(2008) - et al.
Wound healing in sepsis and trauma
Shock
(1997) - et al.
Benefit of percutaneous injection of autologous platelet–leukocyte-rich gel in patients with delayed union and nonunion
Eur Surg Res
(2008) - et al.
The use of autologous platelet–leukocyte gels to enhance the healing process in surgery, a review
Surg Endosc
(2007) - et al.
Antimicrobial peptides from human platelets
Infect Immun
(2002)