If we had told you years ago that platelet-rich plasma (PRP) could heal even the most difficult wounds, you might have laughed and said that’s nonsense. After all, medical technology had made tremendous progress, but there was little to no evidence that PRP could work such magic.
In the words of Captain Jean-Luc Picard of Star Trek, “Things are only impossible until they’re not.”
Studies have shown time and time again that PRP can produce positive clinical outcomes, even in conditions or situations that were previously thought to have no hope. And if we could pick one medical field in which PRP might truly revolutionize outcomes, we would pick wound healing. In fact, we believe PRP could be a wound healing physician’s best ally.
Following are a few cases where PRP has shown effectiveness in wound healing.
Foot ulcers affect around 15% to 25% of patients with diabetes, making them one of the most common complications among these patients.1 Common underlying causes of foot ulcers include poor glycemic control, underlying peripheral neuropathy, poor circulation, poor foot care, dry skin, etc. Unfortunately, foot ulcers are a portal to infections, which can progress to the point where they require the foot to be amputated. Based on available data, about 15% of patients with diabetic foot ulcers require amputation.2
Naturally, clinicians and patients are determined to avoid amputations whenever possible. To do so, they need to prioritize healing the ulcers as quickly as possible. But due to the impaired wound healing mechanisms in patients with diabetes, healing is easier said than done. For example, hyperglycemia has a negative impact on neutrophil function, which is thought to affect the wound healing cascade.3
Studies are beginning to show that PRP may help, thanks to its richness of growth factors, proteins, proteases, cytokines, and protease inhibitors. A systematic review evaluated the safety and clinical effectiveness of PRP for the treatment of diabetic foot ulcers compared to other therapies. They found that PRP increased the likelihood of chronic wound healing and decreased the ulcer volume and time to complete wound healing .4 They also concluded that “further trials are unlikely to overturn this positive result.”
Chronic, nonhealing ulcers have a major impact on patients’ personal, social, and professional lives. PRP therapy has been shown to be a breakthrough in treating nonhealing ulcers. Case series published by Suthar and colleagues in 2017 detailed the treatment of 24 patients who were treated with PRP for nonhealing ulcers of different etiologies. Remarkably, all patients showed signs of wound healing by the end of the 24-week study. The mean time to ulcer healing was only 8.2 weeks.5
In another study, 27 patients with different types of nonhealing ulcers were treated with either PRP or conventional treatment. The group treated with PRP showed a stable and positive healing rate throughout the treatment, leading to a reduction of more than 1 mm in ulcer depth. This group also showed a small decrease in ulcer area (4.5 mm2). On the other hand, the group that received conventional therapy showed an increase in ulcer area over the 5-week treatment.6
Skin grafting is a method used to close lost or damaged skin, such as those resulting from cancer or burns. The procedure involves the creation of another wound at the donor site, which will also produce a scar.
Traditionally, clinicians use a primary dressing to ensure the wounds aren’t left open. But some patients still experience significant discomfort at the donor site due to the exposure of sensory nerve endings. A delay in healing can also occur.
In a study published in the Journal of Wound Care, investigators explored whether the application of PRP over split-thickness skin graft (STSG) donor sites could promote healing and reduce pain. A total of 100 patients were divided into two groups: the intervention group in which patients received a topical application of PRP at the donor site, and a control group in which the wound was dressed traditionally. When the dressing was opened on post-op day 14 and evaluated for healing, the PRP group showed significantly faster healing than the control group. In fact, the control group required dressings for 3 to 4 weeks postoperatively. The PRP group also scored their pain much lower than the control group, showing PRP can be used to manage donor sites for STSGs.7
Similarly, 15 patients who underwent STSGs had one-half of their donor site treated with PRP and the other half dressed using paraffin gauze piece only. The overall healing for both halves was the same by day 21. However, the severity of pain and pruritus in the PRP group was significantly lower, and epithelization also occurred faster on days 7 and 14. This small study showed that PRP can be an effective adjuvant in the management of skin graft donor sites.8
An increasing number of patients are turning to less or non-invasive therapies like PRP to treat various conditions. From 2010 to 2014, annual charges to Medicare for PRP injections increased 400%, from $500,000 to more than $2 million.
Despite the surge in interest, many patients may find PRP therapy inaccessible – simply because insurance companies still view PRP as “experimental” and/or “investigational” for many conditions. As a result, they’re stuck relying on conventional treatments that often work slowly or have side effects.
The global PRP market was valued at $546.6 million USD in 2021 and it’s only expected to expand at a compound annual growth rate of 15.11% by 2030.9 To put it bluntly, PRP isn’t going anywhere; the earlier you get involved with PRP, the more benefits (both for patients and for your practice) you’ll see. It can be the single best addition to your therapeutic rolodex.