VLU management : comparing effectiveness of platelet-rich plasma treatment and conventional therapy

Abstract

Overview of the topic: Venous leg ulcers (VLU’s) are the most dominant type of leg ulcers, resulting from chronic venous insufficiency (CVI). Venous leg ulceration impacts negatively the health related quality of life (HRQoL) due to its physical, social and mental connotations. Prolonged healing results in an increase of the economic burden imposed on National Health Sector, the patients and the immediate family of the patients. The standard of VLU care is compression therapy applied by bandaging an affected limb using the multi-layered, elastic bandage/stockings, followed by irrigation of the wound and moist dressing application. However, an appropriate treatment does not ensure the full closure of the wounds, which often remain unhealed. Autologous platelet rich plasma (PRP) application is a simple, low cost procedure that has shown to have a potential to improve the healing rates. Autologous PRP reduces healing time by releasing growth factors which promote new vasculature and improve wound healing rates. Aim: The aim of this dissertation is to see if PRP in Venous Leg Ulcer management improves healing rate when compared with conventional therapy. Research question: Amongst the patients with VLU’s does PRP treatment improve the healing rates when compared to the conventional therapy? PICO elements: Population - patients with VLU’s. The intervention is PRP and its’ products. The comparison is conventional wound care (which include saline irrigation and/or moist/silver dressing). The presumed outcome is improved healing rates. Methods: The key terms were identified by using the PICO framework in order to generate alternative terms. The research was carried out with using search tools including; Boolean operators, wild cards and truncations. The researched databases include EBSCO, PubMed, Scopus and Science Direct. Limiters were also applied to refine the search. The PRISMA 2009 Checklist was used to screen and exclude non-related articles. Results: Six key studies were identified including four randomized controlled trials (RCT) and two systematic reviews with meta-analyses. All studies detected statistically significant difference amongst the results between the intervention and control groups. Conclusion: This dissertation identified strong evidence proving the advantages of the PRP therapy in VLU healing. However, further research is necessary in order to obtain higher quality evidence and answer this PICO question. Recommendations for further research: Suggestions include the conduction of the trials involving a larger sample as well as performing a research in a local context. Moreover, the research intervention should be limited to one type of PRP. Recommendations for future practice include implementing PRP therapy use in the local settings, at the same time providing the training to the potential therapy providers, such as nurses and doctors. Recommendations for management include the definition of the guidelines and workshops to educate HCP. Recommendations for education include providing education to HCP and patients.