Use of platelet-rich plasma (PRP) to heal post-operative defects at the radial forearm free flap donor site

Excerpt

Since first reported by Yang et al. in 1981, the radial forearm free flap (RFFF) hkas gained popularity for reconstruction of soft tissue defects in the head and neck and is currently one of the main free flaps extensively used worldwide [1‐4]. Generally, closure of the RFFF donor site can only be achieved as originally planned for small defects, and usually covering the defect with a skin graft is required. Different techniques have been reported in the literature for closure of the donor site with a skin graft, and these include a split-thickness (STSG) or full-thickness (FTSG) skin graft harvested either locally or from another part of the body such as the thigh or the abdomen, or using allogenic material [1‐4]. Possible side effects in the post-operative period include impaired healing of the skin graft with exposure of the flexor tendons, reduced hand strength, or unsatisfactory esthetic appearance. Flexor tendon exposure may lead to scar formation and stiffness of the wrist, with reduced functionality of the hand. Therefore, when exposure of the flexor tendons occurs, usually coverage with a second skin graft is required with consequent adjunctive morbidity and delay in discharge of the patient. An alternative option is represented by medication of the defect at the donor site level using a gel concentrate of platelet-rich plasma (PRP). PRP is a source of growth factors (GFs), obtained by sequestering and concentrating platelets. Platelet α granules release growth factors, cytokines and chemokines, which accelerate physiological tissue regeneration mechanisms. The main growth factors involved are as follows: TGF-β (transforming growth factor β), BMP (bone morphogenetic proteins), PDGF 1–9 (platelet-derived growth factor), IGF I and II (insulin-like growth factor), and FGF (fibroblast growth factor). The possibility of having platelet gel concentrate GFs activated by recalcification makes it possible to produce an increase in the concentration of tissue growth factors locally, which accelerates healing and regeneration in the surrounding tissue [5‐7]. The use of PRP has been widely described in the literature in many fields of medicine as a hemostatic agent and as a biomaterial for regenerative purposes with good outcomes [8‐10]. We present a sample case with a relapse following treatment of squamous cell carcinoma of the tonsil with radiochemotherapy. This was treated surgically with radical removal of the neoplasm and reconstruction using a RFFF. The donor site defect at the forearm level was covered with a FTSG harvested locally. In the post-operative follow-up, impaired healing of the FTSG was observed with exposure of the underlying tendon of the brachioradialis muscle (Fig. 1). The patient underwent repeated medication with PRP gel (twice a week with a total of 10 applications) with complete restitutio ad integrum of the cutaneous portion of the proximal volar segment in the left forearm in 40 days.

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