Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury

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Abstract

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.

Cytokines are important mediators of healing. Application of autologous platelet-rich plasma enriched in growth factors and antimicrobial proteins, known also as platelet–leukocyte rich plasma (PLRP), represents a novel approach to the treatment of soft tissue and bone healing disturbances. This case is the first report on the application of PLRP in an infected high-energy soft tissue injury and shows that the volume and concentration of platelets and leukocytes is adequate to induce healing processes despite concurrent infection.

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.

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