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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2004 December;11(4):155-61
The effectiveness of platelet gel in neoangiogenesis and tissue regeneration in “vascular” patients presenting trophic lesions resistant to local treatment
Rivellini C. 1, Mastromarino A. 1, Rughetti A. 2, Dell’Orso L. 2, Masturzo M. 1, Ventura M. 1
1 Cattedra e Scuola di Specializzazione in Chirurgia Vascolare Università degli Studi di L’Aquila, L’Aquila
2 Servizio Immuno Trasfusionale Ospedale San Salvatore, L’Aquila
Aim. It is well known that platelets play an active role in tissue repair and in producing, storing and releasing growth factors such as PDGF, TGF-β, EGF, and IGF-I/II, capable of stimulating the replication of cells of mesenchymal origin (fibroblasts, osteoblasts and endothelial cells). They are also responsible for the presence of macrophages, monocytes and polymorphonucleate cells at the lesion site.
Methods. A total of 30 patients with trophic lesions of varying origin, both arterial and venous, were treated with either autologous or homologous Platelet Gel (PG). None of the patients’ ulcers had responded to other local treatment. PG was used in conjunction with the medical or surgical treatment of the pathology causing the lesion. Triple bags were used in the preparation of the PG: 150-450 ml of whole blood was collected (in 6 cases autologous and in 24 homologous) and centrifuged to obtain: a) concentrated erythrocytes (immediately reinfused for autologous cases); b) platelet rich plasma (PRP) in 15-20ml of plasma; c) platelet poor plasma (PPP) for the preparation of 15-20 ml of cryoprecipitate (CP). The PRP was added to the CP in sterile condition and divided, on average, into 5 aliquots of 7-10 ml, one of which was used immediately whilst the others were stored at -80°C, as lysed platelets. PG was obtained by adding 1ml of 10% calcium gluconate and 1ml of Batroxobin and used immediately. Patients were treated once a week with PG which was left in place for 3 days and then removed.
Results. After a few months, a clear-cut improvement was seen in 90% of cases: the lesion healed completely in 20% of these cases and in 70%, there was a marked reduction in the extent and depth of the lesion. Bacteriological analyses carried out before treatment were positive, in 90% of the cases, for multiresistant pathogens; after treatment a major sensitivity to the various classes of antibiotics was noted but a total sterilization of the lesion was not achieved. In all cases a marked reduction in pain was reported. The lack of a positive outcome in 10% of cases was due to a worsening of the pathology at the root of the lesion or a worsening of the patient’s conditions.
Conclusion. The unexpectedly successful results of PG on lesions resistant to conventional treatment will surely be of interest to all those involved in the treatment of this problem which is of both economic and social relevance. However, further study into the methodology involved, the mechanisms of action and the medical-legal implications is required, as well as a standardization of the protocols involved.