Minimally Invasive Successful Reconstruction of a Severely Traumatized Upper Extremity Using Platelet-Rich Plasma and Tissue Scaffold: A Case Report (original) (raw)
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Tissue Engineered Successful Reconstruction of a Complex Traumatized Lower Extremity
Journal of Orthopaedic Case Reports, 2021
Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds. Case Report: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which “took” completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly. Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient’s quality of life significantly. Keywords: Mangled extremity, Limb salvage, Financial, Trauma, Modified negative pressure wound therapy, Wounds, Wound healing, Soft tissue defect, Knee joint, Tissue engineering, Biodegradable temporising matrix.
Platelet rich plasma injection grafts for musculoskeletal injuries: a review
Current reviews in musculoskeletal medicine, 2008
In Europe and the United States, there is an increasing prevalence of the use of autologous blood products to facilitate healing in a variety of applications. Recently, we have learned more about specific growth factors, which play a crucial role in the healing process. With that knowledge there is abundant enthusiasm in the application of concentrated platelets, which release a supra-maximal quantity of these growth factors to stimulate recovery in non-healing injuries. For 20 years, the application of autologous PRP has been safely used and documented in many fields including; orthopedics, sports medicine, dentistry, ENT, neurosurgery, ophthalmology, urology, wound healing, cosmetic, cardiothoracic, and maxillofacial surgery. This article introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality. In summary, PRP provides a promising alternative to surgery by promoting safe and natural healing. However, there are few controlled tria...
Advance Research on Foot & Ankle, 2019
Regeneration is the ultimate aim in the field of multidisciplinary tissue engineering, together with the amelioration or substitution, in a predictable manner, of damaged or missing tissues, an occurrence that presents in a multitude of conditions, including trauma, diseases and aging. To guarantee an ample availability of different tissue engineering techniques, in clinical fields, these need to be changed and adapted in order to render them accessible and relatively easy to apply in everyday clinical routines. Choukroun's Platelet Rich Fibrin (PRF) and its derivatives have been implemented in a vast array of medical fields, as a supranatural concentrate of autologous growth factors, able to simulate tissue regeneration. Platelets have been found inside blood clots, in its entirety, in all its different groups, even if inside the A-PRF group, the platelet counts is higher in the distal portion, distal to the Buffy Coat (BC), compared to L-PRF. T and B lymphocytes, stem cells, and monocytes have been found close to the BC. Lowering the number of spins and increasing the duration of centrifugation in the A-PRF group leads to a higher neutrophil count in the distal portion of the clots. In conclusion, the results of this systematic study have highlighted the positive effects of PRF and its derivatives (A-PRF, i-PRF) in wounds healing, after regenerative therapy of complicated cutaneous foot lesions.
Management of acute complex traumatic wound with a dermal regeneration template: Case report
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2016
BACKGROUND Acute complex traumatic wounds of the lower limbs are usually managed by a combination of multiple debridements, dressing changes, and specialized surgical procedures which may include tissue transfers for the reconstruction of the soft tissue injury. The recovery is lengthy, and the outcome dependent on the initial injury, the surgical procedures undertaken and rehabilitation programs with a multidisciplinary team. METHOD A nine-year-old male patient presented to Kimberly Hospital with an extensive soft tissue injury of the leg associated with a tibia fracture caused by a high velocity pedestrian vehicle accident. RESULTS A combination of proper wound care, "homemade" negative pressure wound therapy dressings, reduction of fracture and use of a dermal regeneration template over the fracture site, followed by skin grafting was used to manage the wound. CONCLUSION The final functional and cosmetic results obtained with the case suggest that the dermal regeneratio...
Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma
Burns & Trauma, 2021
The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons. Innovations in wound care, soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries. In this review, the principles of reconstruction of complex lower extremity traumatic wounds are outlined. These principles include appropriate initial evaluation of the patient and mangled extremity, as well as appropriate patient selection for limb salvage. The authors emphasize proper planning for reconstruction, timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option. The role of different reconstructive and wound care modalities is discussed, notably negative pressure wound therapy and dermal substitutes. The role of pedicled flaps and microvascular free-tissue transfer are discussed, as are innovations in understanding of perforator anatomy and perforator f...
Plastic and Reconstructive Surgery - Global Open
Summary: Diabetic foot ulcers are a significant complication of diabetes, affecting millions globally, and require appropriate antibiotics, surgical debridement, wound care, and metabolic optimization for management. This article presents an innovative hybrid regenerative therapy for reconstructing an infected, traumatized foot wound of a 62-year-old man with diabetes mellitus who presented with a week-old injury after a car accident. At presentation, he had a 14 × 10 cm dorsal foot wound with skin necrosis, pus discharge, and bony instability owing to partial fractures and joint dislocations. Antibiotics were administered to treat multidrug-resistant bacteria and followed by surgical debridement and the application of a portable Velnext negative pressure wound therapy device. Once the wound condition stabilized, hybrid regenerative therapy was performed weekly. Six milliliters platelet-rich plasma and 6 mL platelet-poor plasma were prepared from 27 mL of venous blood mixed with 3 m...
Aesthetic Plastic Surgery, 2009
Background The authors present their experience with reconstructive surgery of the lower extremity for chronic ulcers, evaluating the effects related to the use of a plateletrich plasma combined with fat tissue. Methods A total of 20 patients, 25 to 50 years of age (median age, 40 years), have been managed with platelet gel in the Plastic and Reconstructive Surgery Department at the ''Tor Vergata,'' University of Rome. The patients were affected by both lower-extremity chronic ulcers and vascular disease. Results The authors observed that 16 of 20 chronic lowerextremity ulcers reepithelialized during an average of 9.7 weeks, with platelet releasate suspended on a collagen base (platelet-derived wound-healing factor), compared with 2 of 10 similar wounds treated with medication based on hyaluronic acid and collagen. Collectively, these data provide evidence for the clinical use of platelet technology in the healing of both soft and hard tissue wounds. Conclusions Currently, plastic surgery with autogenous fat grafts can be performed for stabilization of chronic lower-extremity ulcers. The objective of this study was, through the presentation of clinical cases, to suggest a therapeutic plan formed by two sequential treatments: acquisition of platelet gel from a small volume of blood (9-18 ml) followed by the Coleman technique for reconstructing the three-dimensional projection and superficial density of tissues. The results proved the efficacy of combining these two treatments, and the satisfaction of the patients confirmed the quality of the results.
Studies on Ethno-Medicine, 2017
The purpose of this paper was to evaluate the effect of platelet-rich plasma (PRP) application after the contusion muscle injury. In the study, New Zealand type rabbits were placed into a trauma model. The rabbits were divided into three groups. In the 1 st group PRP was applied just after the trauma, in the 2 nd group PRP was applied one day after the trauma and in the 3 rd group PRP was not applied. Fibrosis decreased in the groups in which PRP was applied in the first day or in the first hour but fibrosis increased in the control group steadily. Dystrophic calcification developed less in the group in which PRP was applied in the first hour compared with t he control group. It is concluded that particularly with its effect on dystrophic calcification, PRP may reduce the possibility of re-injuries and and help athletes in terms of returning to sports more quickly.
Seminars in Vascular Surgery, 2015
Dermal tissue loss in patients affected by critical limb ischemia represent a serious wound healing problem, with high morbidity, prolonged hospital stay, and high patient care costs. Treatment of ischemic foot lesions required limb revascularization by endovascular or open surgical intervention and individualized patient-specific wound care; including antibiotic therapy, devitalized/infected wound debridement, and advanced wound dressing. In selected patients, spinal cord stimulation, vacuum-assisted closure therapy, and bioengineered tissue or skin substitutes and growth factors have been shown to improve wound healing. In this study we present our preliminary results about the topical application of autologous platelet-rich plasma to enhance the process of wound healing after revascularization of lower limbs, in patients affected by critical limb ischemia.
Journal of Bone and …, 2009
Although mechanical stabilisation has been a hallmark of orthopaedic surgical management, orthobiologics are now playing an increasing role. Platelet-rich plasma (PRP) is a volume of plasma fraction of autologous blood having platelet concentrations above baseline. The platelet α granules are rich in growth factors that play an essential role in tissue healing, such as transforming growth factor-β, vascular endothelial growth factor, and platelet-derived growth factor. PRP is used in various surgical fields to enhance bone and soft-tissue healing by placing supraphysiological concentrations of autologous platelets at the site of tissue damage. The easily obtainable PRP and its possible beneficial outcome hold promise for new regenerative treatment approaches. The aim of this literature review was to describe the bioactivities of PRP, to elucidate the different techniques for PRP preparation, to review animal and human studies, to evaluate the evidence regarding the use of PRP in trauma and orthopaedic surgery, to clarify risks, and to provide guidance for future research.