Platelet-Rich Plasma (PRP) in the treatment of Wounds with Exposed Skull

Introduction: Platelet-rich plasma (PRP) is an autologous blood-derived product that contains platelet concentrations, cytokines, and platelet-related growth factors. Since the 1980s, the use of PRP to promote healing has gained attention in a multitude of medical fields, including orthopedics, cardiology, plastic surgery, and wound medicine.1,2,3 The application of PRP within a wound bed accelerates and ameliorates the repair of bone, muscle, tendon, and subcutaneous tissues, promoting wound healing. Skull wounds are often challenging to treat, given the bone-level involvement and thin layers of tissues. This case series aims to illustrate the use of PRP in treating full-thickness skull wounds to promote wound closure.1,3Methods:Three patients with full-thickness skull wounds were treated with standard of care (SOC) and the application of PRP.  All wound beds were prepared with SOC treatment, including thoroughly cleaning the wound and debridement of nonviable tissue through sharps or ultrasonic debridement method.  The PRP concentrated biologic was obtained through centrifugation of the patient's whole blood.  The PRP was isolated and administered to the injurious tissue.  A primary dressing was then applied to secure the PRP to the wound bed and protect the peri-wound.  A secondary dressing was then applied to ensure absorption of excess drainage.  The PRP was left in place for seven days.  Secondary dressings are changed 2-3 times weekly.  The process was repeated weekly for up to 20 applications or until the wound was healed.Results:Overall wound closure was appreciated in all wounds with the use of PRP in conjunction with SOC.  Wound etiologies included surgical and squamous cell carcinoma.  Patient comorbidities included diabetes, hypertension, and adrenal insufficiency.  The number of PRP applications ranged from 3 to 4 weeks and wound sizes ranged from 0.24 to 9 cm2.  The time to complete wound epithelialization ranged from 30 to 60 days.Discussion: PRP is a valuable advanced modality in treating chronic skull wounds.  This case series exhibits successful treatment of PRP in conjunction with SOC for complex skull wounds.  Adequate wound bed preparation is necessary to ensure the utmost benefits of PRP.  Further, ensuring repeat application and proper dressing promotes wound healing.  Current literature supports the effectiveness of PRP as an advanced modality to enhance wound healing compared to conventional therapy alone.  However, further research is needed to determine the efficacy of PRP in conjunction with other advanced modalities, such as skin substitute allograft. References:1. Gonzalez dos Santos, R., Santos, G. S., Alkass, N., Chiesa, T. L., Azzini, G. O., Furtado da Fonseca, L., et al. (2021). The regenerative mechanisms of platelet-rich plasma: A review. Journal of Cytokine, 144(155560), https://doi.org/10.1016/j.cyto.2021.155560 2. Meznerics, F. A., Fehervari, P., Dembrovszky, F., Kovacs, K. D., Kemeny, L. V., Csupor, D., et al. (2022). Platelet-Rich plasma in chronic wound management: A systematic review and meta-analysis of randomized clinical trials. Journal of Clinical Medicine, 11(24), 7532. https://doi.org/10.3390/jcm11247532 3. Nazaroff, J., Oyadomari, S., Brown, N., Wang, D. (2021). Reporting in clinical studies on platelet-rick plasma therapy among all medical specialties: A systematic review of Level I and II studies. PLoS ONE, 16(4), 1-11. https://soi.org/10.1371/journal.pone.0250007