In summary, A-PRP/thrombin gel in combination with STSG (split thickness skin graft) could improve the healing time of complex and difficult wounds, providing a basis for healing skin loss after NSTI (necrotising soft tissue infection) without side effects and with minimal recovery time.
Barbara Hersant et al. - Autologous Platelet-Rich Plasma/Thrombin Gel Combined with Split-Thickness Skin graft to Manage Postinfectious Skin Defects: A Randomized Controlled Study, 2017
Fig. above: A-PRP® Plus ATS application by means of spray applicator under and on the split skin.
Fig. bottom left: 2 days after treatment.
Complete healing: 3 weeks after treatment.
44-year-old man with Fournier's gangrene. Aggressive debridement of the necrotic tissue was performed in the operating room. After wound bed preparation, A-PRP/Thrombin gel was sprayed onto the wound bed (above) and onto the meshed split skin graft after fixation with staples. The figure on the bottom left shows wound healing 2 weeks after the skin graft.
Complete healing was achieved 45 days after the skin graft (bottom, right).
Managing cutaneous substance loss after debridement is challenging, especially when secondary to necrotising soft tissue infection (NSTI), such as necrotising fasciitis and Fournier's gangrene. After skin graft reconstruction, the healing process is longer and can be difficult, depending on the position of the wound, the size of the skin defect and the patient's comorbidities.
The aim of this study was to investigate whether autologous platelet-rich plasma (A-PRP) can promote wound healing after cutaneous reconstruction secondary to soft tissue infection in the setting of tissue loss.
Methods & Materials:
A prospective, controlled, randomised, open-label study was conducted. Patients (N = 27) were randomised into 2 groups by drawing lots using sealed envelopes: an experimental (n = 14) and a control group (n = 13). First, all necrotic tissue was extensively debrided and excised. In the experimental group, patients received a split thickness skin graft (STSG) combined with A-PRP/thrombin gel applied to the wound bed and to the STSG after fixation with staples. In the control group, patients underwent STSG alone.
The results showed that the mean complete healing time was significantly reduced (by almost 50%) when A-PRP/thrombin gel was combined with STSG compared with STSG alone (37.9 [SD, 14.3] days in the experimental group versus 73.7 [SD, 50.84] days in the control group, P = .01).
No patients experienced complications during the follow-up period.
The combination of A-PRP/thrombin gel and STSG significantly improved clinical outcomes and reduced wound healing time. Therefore, this treatment combination could be a way to heal the skin after a necrotising soft tissue infection with minimal recovery time.