Diabetic foot ulcers are a major cause of morbidity in diabetic patients, severely affecting quality of life and often leading to limb loss. Growth factors have been suggested as a useful tool for ulcer healing in such patients. These are biologically active polypeptides that alter target cell growth, differentiation and metabolism of target cells and stimulate cell proliferation, chemotaxis and angiogenesis.
Kontopodis et al. Effectiveness of platelet-rich plasma to enhance healing of diabetic foot ulcers in patients with concomitant peripheral arterial disease and critical limb ischemia, Int J Low Extrem Wounds, 2015.
Diabetes is a major health problem that is currently showing an alarming increase in its prevalence. The prevalence was recently estimated at 7.8% in the United States, an increase of more than 50% in the last 15 years, while there is a large population undiagnosed with diabetes. Diabetic foot ulceration (DFU) is an inevitable event in the clinical course of many patients, up to 25% of whom will suffer from a foot ulcer in their lifetime. Approximately 20% of these ulcers eventually require amputation and 85% of all diabetic lower limb amputations are preceded by an ulcer. It is worth noting that these patients have a 15 to 30 times higher risk of amputation than patients without diabetes.
Methods & Material:
We investigated the effect of autologous platelet-rich plasma (PRP) on the healing rate of diabetic foot ulcers in patients with diabetes and concomitant peripheral arterial disease (paVk).
Patients treated with local growth factors at a single centre over a 24-month period, from May 2009 to April 2011, were retrospectively reviewed. Based on the severity of paVk, patients were divided into groups A (Fontaine classification levels I, IIa and IIb) and B (Fontaine classification levels III and IV), with those included in the latter group having critical limb ischaemia (CLI). The endpoints of the analysis were clinical improvement, limb salvage and amputation rate.
Outcome was compared between groups A and B. A total of 72 patients were evaluated, 30 of whom had CLI. A reduction in ulcer area of >50% was observed in 58/72 patients, and a reduction of >90% was achieved in 52/72 patients.
There were 14 (19%) major and minor amputations, while the limb salvage rate was 89%. This variable differed significantly between groups A and B (100% vs 73%, P < .001), as did the rate of ulcer area reduction >90% (83% vs 56%, P = .02).
A reduction in ulcer area >50% was observed in the majority of patients in both groups (group A 86% vs. group B 73%, P =.23).
In conclusion, PRP can serve as a useful tool in the management of diabetic foot ulcers, even in diabetic patients with non-reconstructable arterial disease.