Diabetic foot ulcer healing : autologous platelet-rich plasma vs conventional management

Abstract

Background: Diabetic foot ulcers (DFUs) are a global health threat that results in significant morbidity and mortality rates (Pendsey, 2010). Conventional topical DFU management include; vascular assessments, glycaemic control, surgical debridement, offloading and a variety of dressings (including saline) that promote moist wound beds and exudate control. Over the past couple of decades adjuvant therapies have been studied to increase healing rates, including autologous platelet-rich plasma (aPRP), which aims to initiate the body’s natural healing process. Since diabetic patients are deficient in biological stimulators due to metabolic impairment and ischaemia, the healing process is disrupted, thus the synergistic effect of aPRP’s growth factors compensates for that deficiency to induce platelet aggregation, angiogenesis, and skin epthelialisation (Waniczek et al., 2013). Methods: A research question was formulated using the PICO framework: As an adjunct to standard care, is aPRP therapy effective in the healing of DFUs when compared to conventional therapy? (P: patients with DFUs, I: aPRP therapy of DFU, C: conventional therapy, O: DFU healing). A systematic literature search was performed using electronic databases and manual searches which included inclusion criteria that consisted of peer-reviewed journals in English text, studies enrolling participants aged ≥18 years, topical aPRP application, and follow up of ≥ 3 weeks. 7 RCTs were retrieved and critically appraised using the RCT CASP tool (2020) and ethical considerations were applied. Results: All key studies found a significant positive difference in DFU healing when aPRP was compared to conventional management despite methodological issues. The therapy was deemed both safe and effective, however, authors advise further research on larger sample sizes. Implications & Recommendations: Further research is imperative to ascertain aPRP effectiveness and safety, prior to its introduction to the Health care system in Malta. Educational interventions to healthcare students, professionals, and patients are further needed on DFU prevention and management. Stakeholder collaboration to introduce aPRP locally was highlighted.