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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2010 March;8(1):21-32
Growth factors treatment of lower limbs amputation stumps: the role of the platelet gel
Di Domenico G., Leonardi G. M., Guerra Narducci V., Mottola M., Nocera C.
1 UOC di Immunoematologia e Medicina Trasfusionale, PO “S. Giovanni Bosco”, ASL NA 1 Centro, Napoli, Italia
2 UOC Chirurgia Urgenza. PO “S.Giovanni Bosco”, ASL NA 1 Centro, Napoli, Italia
3 UOC di Immunoematologia e Medicina Trasfusionale, AORN Monaldi, Napoli, Italia
Aim. The platelet growth factors (PGF) are released, as in vivo as in vitro, from the platelets after their activation. The PGF are liable to numerous biological functions such as the proliferation and differentiation of mesenchimal stem cells, re-epithelialization, angiogenesis. This PGF ability to regulate the mechanisms of the wound healing has enhanced the biological background of the topical therapy of wounds and soft- tissue injuries with platelet gel (PG). The peripheral chronic obstruction artery (PCOA) is a multi step aetiology disease, which induces high incidence of amputations of the inferior and/or superior limbs, followed by prolonged hospitalizations and a long period of cares and medications. For the reason given above, numerous studies have shown an unfavorable economic evaluations of the wound care management of the amputated patients, which regret persistence of the pain and a disagreeable quality of life until the entire recovery period. The aim of the present work was to show the efficacy of the therapy with the PG for to prevent the microbiological infections and for to enhance the wound repair of the stumps amputation of the inferior limbs.
Methods. From December 2007 to December 2008, 20 patients suffering from chronic wounds of the stump amputation of lower limbs were treated. There were 10 males and 10 females, aged from 57 to 81 years. Immediately after the vascular surgery treatment, the patients were submitted to PG therapy application, combined with a systemic and topic antibiotic therapy, until the entire sterilization of the stump. Besides, the PG application was executed into a sandwich of the silver Sulfadiazin/jaluronic acid followed by an occlusive bandage, repeated every 7 days.
Results. All the patients showed, since the first application of PG, a smaller pain which was reduced of 70% after two weeks and imperceptible after a month. Besides, all the stumps were free from microbiological infections, since the first applications of PG and they maintained the sterility until the recovery. The stumps showed a different size at the start of the study; they resulted reduced of 50% of the size after a month of treatment and 19/20 stumps resulted closed after 1-3 months. Alone a stump has shown a refractory to the PG treatment after 7 months of therapy.
Conclusion. The data of our work show that the use of the PG combined with a sandwich of the silver Sulfadiazin/hyaluronic acid produce a type of an advanced medication which reduces the local inflammation and the pain; at the same time, this therapy is able to prevent the microbiological infections. On the other hand, the times of recovery result earlier of the 50-70% with respect to the patients that do not receive the same treatment (data of the literature). For that purpose, the PG therapy is able to avoid the recourse to successive invasive surgical technique of plastic surgery, in the amputated patients.