Role of local application of autologous platelet-rich plasma in the management of pressure ulcers in spinal cord injury patients

Study design: Prospective clinical case series. Objectives: The objective of this study is to evaluate the local application of platelet-rich plasma (PRP) in relation to pressure ulcers (PrUs) healing on one PrU (case) versus saline dressing on another PrU (control) in the same patient. Setting: Tertiary Level Care Centre, India. Methods: Twenty-five spinal cord injury patients with at least two PrUs were included. All 25 PrUs (case) were grade IV, and PrUs (control) were grade II (n = 11), grade IV (n = 10) and grade III in 4 patients. Evaluation of PrU healing was done by measuring wound surface area, Pressure Ulcer Scale for Healing (PUSH), biopsy and clinical examination. Results: Statistically significant decrease in mean PUSH scores of PrUs (case) (t = 6.13, P<0.000) and PrUs (control) (t = 3.98, P = 0.000) was observed after 5 weeks. The wound surface area of PrU (case) decreased significantly (t = 4.98, P = 0.000); however, the decrease was not significant (t = 0.095, P = 0.924) in PrUs (control). Majority of histopathological pictures of PrUs (case) showed necrosis and suppuration (56%) at the time of enrollment and well-formed granulation tissue and epithelialization (60%) at the 5th week. Twenty-four (96%) PrUs (case) improved and only 1 deteriorated with PRP therapy, whereas in control group 17 (68%) PrUs improved, 7 (28%) deteriorated and 1 wound showed no change. Conclusions: Advanced wound therapy using local applications of PRP seems to be a promising alternative to standard saline dressings in PrU healing. With the advantages of simple preparation, biocompatible safety, low cost and significant clinical effectiveness, it may be beneficial to study the effects of PRP in large-scale trials to validate it as an ideal therapy for enhanced wound healing in PrUs.