自体富血小板血浆治疗1例血友病A患者膝关节术后慢性难愈合创面

Treatment of chronic refractory wound with autologous platelet-rich plasma in a hemophilia A patient after knee joint surgery

2017年12月22日,1例35岁左膝关节术后继发慢性难愈合创面的血友病A男性患者从茂名市人民医院血液内科转入该院烧伤整形科。体格检查见其左膝关节肿胀,关节外侧有4 cm×4 cm大小的全层皮肤缺损创面,基底有大量暗红色血凝块。予静脉滴注血浆、冷沉淀和人凝血因子Ⅷ控制创面出血,常规清创换药至创面感染控制、坏死组织清除后,左膝关节残留2 cm×2 cm大小、3 cm深的皮下腔隙创面难以愈合。转科19 d后行自体富血小板血浆(PRP)治疗,PRP治疗32 d后左膝关节创面上皮化愈合。该病例提示,对于血友病合并慢性难愈合创面,在无法通过手术修复时,自体PRP治疗会是一个很好的选择。

On December 22,2017,a 35-year-old male hemophilia A patient with a secondary chronic refractory wound after left knee joint surgery was transferred from the Department of Hematology of Maoming People's Hospital to the Department of Burns and Plastic Surgery in the same hospital.The physical examination revealed that the patient's left knee joint was swollen,with a full-thickness skin defect wound of 4 cm×4 cm on the lateral side of the joint and a large number of dark red blood clots at the bottom of the wound.The wound bleeding was controlled by intravenous infusion of plasma,cryoprecipitate,and human coagulation factorⅧ.After con-ventional debridement and dressing changes until the wound infection was controlled and necrotic tissue was removed,a subcutaneous cavity wound of 2 cm×2 cm in area and 3 cm in depth remained in the left knee joint and was difficult to heal.Nineteen days after transfer,the patient received autologous platelet-rich plasma(PRP)treatment,and 32 days after PRP treatment,the wound in left knee joint was healed with epithelialization.This case suggests that autologous PRP therapy would be a good option for hemophilia complicated chronic refractory wounds when they could not be repaired by surgery.