PRF Treatment for Wound Care in Shelton, CT
Diabetes
In 2021, it was estimated 537 million people worldwide are diabetic. 463 million people represent 9.3% of the global population ages 20-79. This number is expected to increase to 643 million in 2030 and 783 million by 2045. In the United States, in 2020, 34.2 million people of all ages (10.5% of the population) has diabetes, with Pacific Islanders and American Indians having the highest rate of Diabetes in the US.
Diabetes is responsible for 6.7 million deaths in 2021-1 every 5 seconds. Diabetes caused at least USD 966 billion dollars in health expenditure- an increase of 316% over the last 15 years. In the US, 1 in 7 adults are living with diabetes. The number of adults in the US is expected to reach 57 million by 2030 and 63 million by 2045. 1 in 4 adults living with diabetes are not diagnosed. 931,000 deaths caused by diabetes in 2021. USD 415 billion spent on diabetes in 2021.
Foot Ulcers in Diabetes
The annual incidence of foot ulcers world-wide is between 9.1 to 26.1%.
Around 15 to 25% of patients with diabetes mellitus will develop a foot ulcer during their lifetime.
The causes are peripheral neuropathy (nerve damage) and lower extremity ischemia (lack of blood flow) due to peripheral artery disease are the primary cause of diabetic foot ulcers. Patients with diabetic foot ulcers are commonly seen by a healthcare provider about 14 times a year and are hospitalized about 1.5 times a year. The cost to Medicare is about $33,00 yearly per patient. Leg ulcers are commonly caused by venous disease accounting for almost 80% of all lower extremity ulcerations. Peak incidence is between 60-80 years of age. Approximately one third of patients with chronic venous insufficiency will develop venous ulcers before the age of 40.
Although there is no evidence that diabetes causes venous diseases like varicose veins or deep vein thrombosis, there is evidence that diabetes makes these patients more susceptible to diseases affecting the health of the veins in the lower extremity affecting overall vein health. Varicose veins, spider veins and DVT can then develop leading to venous ulcers.
Over time, high blood glucose levels can weaken the veins and damage blood vessels. These weakened vessels are then more susceptible to infection. The infection can lead to skin breakdown and ulcer development.
Signs of Diabetic Foot Problems
- Changes in skin color
- Changes in skin temperature
- Swelling
- Pain in the legs
- Open sores that are slow or do not heal.
- Fungus in the nails
- Dry cracking skin
- Decreased sensation
Treatment of Diabetic Foot Ulcers
- Primary Goal is to manage the blood sugar.
- Treatment and prevention of infection
- Off Load the area- take pressure off
- Debride the dead tissue.
- Apply covering to the area and medication.
- PRF
Treatment of Leg Ulcers
- Cleaning the area of dead tissue- surgical debridement may be needed.
- Specialized wound dressings to augment the various stages of wound healing.
- Occlusive dressings
- PRF
Platelet Rich Fibrin (PRF)
Platelet Rich Fibrin is an autologous leukocyte and platelet rich fibrin biomaterial that is produced from the patient’s own blood and can be used for a variety of applications including wound/ulcer healing. It is well known and documented, platelets participate in homeostasis, angiogenesis inflammation and tissue repair and regeneration. Growth factors released from platelets precipitate and stimulate the differentiation of mesenchymal stem cells involved in the healing process. The ability to provide super-physiologic doses of platelets to an area of tissue damage is the basis of platelet rich plasma and platelet rich fibrin.
The Platelet Rich Fibrin forms a dense fibrin network that enables slower degradation rate and therefore delayed release of growth factors to the surrounding tissue for healing and regeneration. The release of growth factors from PRF has been reported up to 7 days for the majority of applications and in one study, the growth factors were elevated after 30 days.
In wound applications, the advantages of the combination of both platelet rich plasma and platelet rich fibrin are:
- Completely autologous product with no antigenicity
- No biochemical handling as in hydrogels
- Contains growth factors and cytokines involved in wound healing.
- Has leukocytes present to fight infection.
- Highly flexible and elastic
- PRF shows extended growth factor release.
- Cost is inexpensive vs. hydrogels.
- Comparative Release of Growth Factors from PRP and PRF and Advanced-PRF
Clin Oral Investig 2016 Dec; 20(9): 2353-2360. PMID 26809431
Purpose: The use of platelet concentrates has gained increasing awareness in recent years for regenerative procedures. The aim of this study was to compare the growth factor release over time from PRP, PRF and Advanced-PRF (activated)
Conclusion: The results from the present study indicate that the various platelet products have quite different release kinetics. The advantages of PRP is the release of significantly higher proteins at earlier time points whereas PRF displayed a continual and steady release of growth factors over a 10 day period of time. It was also observed that A-PRF releases a significantly higher total quantities of growth factors when compared to traditional PRF.
- Improving Chronic Diabetic Wound Healing through an Injectable and Self-Healing Hydrogel with Platelet Rich Plasma Release
ACS Appl Mater Interfaces 2020 Dec 16; 12(50): 55659-55674 PMID 33327053
Purpose: Diabetic skin ulcer is one of the severe complications of diabetes mellitus which has a high incidence and may cause death or disability. Platelet Rich Plasma is widely used in the treatment of diabetic wounds because of growth factors derived from it. In our study, we fabricated a self-healing hydrogel for promoting diabetic wound healing.
Conclusion: The results showed that it could promote the proliferation of repair cells in vitro. Moreover, it could enhance wound healing by expediting collagen deposition, angiogenesis and nerve repair in a type 2 diabetic rate model and rat skin defect model.
- Platelet Rich Plasma Hydrogels Promote in Vitro and in Vivo Angiogenic Potential of Adipose- Derived Stem Cells
ACTA Biomater 2019 Mar 15;87:76-87 PMID 30665019
Purpose: This work focused on the optimization of a PEGylated platelet rich plasma hydrogel for the protracted release of cytokines, growth factors, and signaling molecules and also the delivery of a provisional framework for stem cell angiogenesis.
Conclusion: Our findings support an innovative means of cellular therapy intervention to improve surgical wound healing in a normal wound model. It could be an efficacious and completely autologous therapy for people who have poorly healing wounds caused by vascular insufficiency, previous radiation or full thickness burns. Because wound healing is a dynamic and complex process, the application of more than one growth factor with ASC demonstrates an advantageous way of improving healing.
RESULTS THAT MAKES A DIFFERENCE.
