Published online Oct 15, 2018. doi: 10.4239/wjd.v9.i10.172
Peer-review started: May 3, 2018
First decision: June 8, 2018
Revised: June 15, 2018
Accepted: June 28, 2018
Article in press: June 28, 2018
Published online: October 15, 2018
Diabetic foot ulcers (DFUs) are among the most common complications of diabetes mellitus but current treatment options are limited. Current standard management consists of surgical debridement followed by frequent dressing changes with tight infection and glycemic control. In recent years, the use of autologous platelet-rich plasma (PRP) has emerged as an adjunctive method for treating DFUs.
Because current studies evaluating the outcomes of topical autologous PRP on diabetic foot ulcers are limited to small randomized controlled studies and case reports. Given that there are numerous confounding variables involved with PRP use, there has been significant challenge in generating standardized protocols for patient use.
The objective was to determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates. The significance of realizing this objective combined with future research consisting of further randomized controlled studies will help evaluate the true efficacy of this treatment.
This review was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV investigations of topical PRP application in DFUs were sought in multiple databases, i.e., MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The search terms used were “platelet rich plasma”, “diabetes”, “ulcers”, and “wound”. The Modified Coleman Methodology Score (MCMS) was used to analyze study methodological quality.
One thousand two hundred and seventeen articles were screened, eleven articles were analyzed, six articles were level II evidence, four were level III, and one article was level IV. The mean MCMS was 61.8 ± 7.3. Healing rate was significantly faster with PRP application compared to controls (0.68 ± 0.56 cm2/wk vs 0.39 ± 0.09 cm2/wk; P < 0.001). Mean heal time to > 90% of the original ulcer area for patients in the PRP group was significantly lower with control groups (7.8 ± 2.7 wk vs 8.3 ± 3.7 wk, P = 0.115). There were significantly lower adverse effects reported with PRP application compared to controls (7 wound infections, 1 contact dermatitis vs 14 wound infections, 1 maceration; P < 0.001).
We find that the topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls. This study proposes the new theory that the use of PRP is a superior option to treating DFUs than the current standard of care. A new hypothesis that may be proposed from this study is that the use of PRP results in clinical outcome improvement in multiple parameters. Combining the findings within this study with future research consisting of further randomized controlled studies that show clinical outcome improvement in multiple parameters will provide adequate evaluation of the true efficacy of this treatment.
The assimilation of heterogeneous studies allowed the development of a high quality systematic review that analyzes two outcome measures. Future studies can improve through designing more prospective comparative trials, increasing study sizes, and standardizing clinical outcome measures such as healing rates, percentage of ulcers completely healed, and ulcer area at baseline and final follow-up.