自体富血小板血浆凝胶在慢性伤口修复中的临床效果

Clinical effects of autologous platelet-rich plasma gel in the repair of chronic wounds

目的探讨自体富血小板血浆(PRP)凝胶在各类慢性伤口修复中的临床应用效果。方法2015年1月—2018年1月,笔者单位收治各类慢性伤口患者76例,其中男39例、女37例,年龄28~75(52±6)岁。术前伤口面积为2.0cm×0.5cm^17.0cm×5.0cm,深度1~6cm,创基面积3cm×3cm^17cm×8cm,深部腔隙容积为7~55mL。入院后2~7d进行手术,单次采集自体血小板220~250mL,制作PRP10~50mL。注射1~3次PRP凝胶,完全填充腔隙。根据伤口具体情况直接缝合或采用局部旋转皮瓣等方式覆盖。Ⅰ期未闭合伤口行持续负压封闭引流治疗。术后行超声、CT或磁共振成像复查,明确腔隙愈合情况。观察患者术后及随访时伤口愈合情况、腔隙修复情况。结果39例患者Ⅰ期术后伤口直接封闭,其中伤口完全愈合者36例;另3例患者经二次清创、PRP凝胶填充后伤口完全愈合。35例患者经1~3次PRP凝胶治疗联合负压封闭引流治疗后,腔隙肉芽组织填充较佳,移植皮片或皮瓣修复后愈合。另2例患者经1次PRP凝胶治疗后中断伤口治疗。术后失访7例。Ⅰ期术后2和/或4个月随访,伤口均愈合较佳、无复发,腔隙被纤维组织填充。结论自体PRP凝胶治疗慢性伤口,具有单次提取量大、使用方式灵活、可充分填充复杂腔隙、手术安全性高、继发损伤轻等优点,是临床修复慢性伤口的新选择。

Objective To explore the clinical application effects of autologous platelet-rich plasma gel in the repair of various chronic wounds.Methods From January 2015 to January 2018,76 patients with chronic wounds were admitted to our unit,with 39 men and 37 women,aged 28 to 75(52±6)years.Before the operation,areas of wounds ranged from 2.0 cm×0.5 cm to 17.0 cm×5.0 cm,depths of wounds ranged from 1 to 6 cm,areas of wounds substrate ranged from 3 cm×3 cm to 17 cm×8 cm,and volumes of deep cavities ranged from 7 to 55 mL.All patients received operation 2 to 7 days after admission.Autologous platelet of 220-250 mL was collected from each patient by single extraction to make platelet-rich plasma of 10-50 mL.The cavity was filled completely by injection of platelet-rich plasma gel for 1-3 times.Wounds were sutured directly or covered by local flaps or other materials according to the conditions of wounds,and the unclosed wounds in primary stage were treated by continuous vacuum sealing drainage(VSD).Ultrasound,CT,or magnetic resonance imaging was performed to detect the healing of cavity after the operation.The healing of wound and repair of cavity after the operation and during follow-up were observed.Results Wounds in 39 patients were closed directly after primary operation.Among them,wounds of 36 patients were healed completely,and wounds of the other 3 patients were healed completely after second debridement and topical filling of platelet-rich plasma gel.The cavities in 35 patients were filled with granulation tissue after treatment of platelet-rich plasma gel for 1-3 times combined with VSD,and the wounds were healed after skin grafting or flap transplantation.The treatment of wounds discontinued in the other 2 patients after treatment of platelet-rich plasma gel for once.Postoperative follow-up was lost in 7 patients.During follow-up of 2 and/or 4 months after the primary operation,wounds were healed well with no recurrence,and cavities were filled with fibrous tissue.Conclusions Autologous platelet-rich plasma gel has advantages in treating chronic wounds,including a large amount by single extraction,flexible use mode,ability to fully fill the complex cavity,high surgical safety,and mild secondary injury.It′s a new choice for repair of chronic wounds in clinic.