Use of platelet-rich plasma and modified nanofat grafting in infected ulcers: Technical refinements to improve regenerative and antimicrobial potential

• Published in: Archives of plastic surgery Vol. 47; no. 3; pp. 217 - 222
• Main Authors: Segreto, Francesco, Marangi, Giovanni Francesco, Nobile, Carolina, Alessandri-Bonetti, Mario, Gregorj, Chiara, Cerbone, Vincenzo, Gratteri, Marco, Caldaria, Erika, Tirindelli, Maria Cristina, Persichetti, Paolo
• Format: Journal Article
• Language: English
• Published: 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Thieme Medical Publishers, Inc 01.05.2020; Korean Society of Plastic and Reconstructive Surgeons; 대한성형외과학회
• Subjects: anti-infective agents; Original; Original Article; platelet-rich plasma; tissue grafts; ulcer; wounds; 성형외과학; Wounds; Anti-infective agents; Ulcer; Tissue grafts; Platelet-rich plasma
• ISSN: 2234-6163; 2234-6171
• DOI: 10.5999/aps.2019.01571

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%±13.8%. 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%±40.8% was found. Pain was fully alleviated in all patients who underwent re-epithelization. A mean pain reduction of 42%±33.3% (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.