Systematic Reviews
Copyright ©The Author(s) 2018.
World J Diabetes. Oct 15, 2018; 9(10): 172-179
Published online Oct 15, 2018. doi: 10.4239/wjd.v9.i10.172
Table 1 Study demographics
Mohammadi et al[6] 2017Ahmed et al[7] 2017Perez-Zabala et al[8] 2016Saad et al[9] 2011Kakagia et al[10] 2007Driver et al[11] 2006Li et al[12] 2015Saldalam-acchia et al[13] 2004Motolese et al[14] 2015Shan et al[15] 2013Kontopodis et al[16] 2016Weighted (mean ± SD)[6]P-value (PRP vs control)
Type of StudyPURPCSRPRPRDBPRPRPPUPURUN/AN/A
Level of evidenceIIIIIIVIIIIIIIIIIIIIIIIIIIN/AN/A
No. patients
PRP7028212171959715217229.3 ± 25.40.104
ControlN/A28N/A12N/A21587N/AN/AN/A25.2 ± 20.0
Age (mean ± SD, yr)
PRP53.8 ± 10.643.2 ± 18.265.5 ± 2.1NR57.0 ± 12.058.3 ± 9.761.4 ± 13.161.1 ± 9.452.3 ± 11.366.5 ± 10.86558.4 ± 7.20.678
ControlN/A49.8 ± 15.4N/ANRN/A55.9 ± 8.164.1 ± 9.458.1 ± 7.8N/AN/AN/A58.7 ± 5.9
Female gender, n (%)
PRP12 (17.1)8 (28.6)0 (0.0)NRNR3 (15.8)22 (37.3)4 (57.1)11 (73.3)13 (61.9)14 (19.4)29.70%0.407
ControlN/A10 (35.7)N/ANRN/A5 (23.8)20 (34.5)4 (57.1)N/AN/AN/A35.10%
Duration of diabetes (mean ± SD, yr)
PRP16.2 ± 7.9NR23.5 ± 13.4NRNRNR7.5016.3 ± 7.938.206.8 ± 6.7NR14.1 ± 11.60.048
ControlN/ANRN/ANRN/ANR10.0019.7 ± 9.9N/AN/AN/A11.0 ± 6.9
Duration of ulcer (mean ± SD, wk)
PRP19.6 ± 4.712.5 ± 1.028.3 ± 9.5NR19.0 ± 8.0NR4.28NRNR10.1 ± 12.0NR13.0 ± 8.4< 0.001
ControlN/A11.5 ± 2.8N/ANRN/ANR3.30NRN/AN/AN/A6.0 ± 5.8
HbA1c (mean ± SD)
PRP6.2 ± 0.77.0 ± 0.59.4 ± 3.3NR8.1 ± 2.87.8 ± 1.59.8 ± 3.19.5 ± 1.7NR9.1 ± 2.2NR7.9 ± 1.3< 0.001
ControlN/A6.9 ± 0.6N/ANRN/A8.1 ± 1.89.808.8 ± 1.7N/AN/AN/A8.7 ± 1.2
Ulcer area (mean ± SD, cm2)
PRP6.11 ± 4.376.24 ± 0.910.25NR28.4 ± 13.63.4 ± 4.54.1027.3 ± 15.613.9214.0 ± 32.34.1 ± 3.97.7 ± 9.3< 0.001
ControlN/A5.72 ± 0.8N/ANRN/A3.6 ± 4.02.9017.0 ± 8.9N/AN/AN/A4.6 ± 6.6
Table 2 Platelet-rich plasma preparation
StudyMohamm-adi et al[6] 2017Ahmed et al[7] 2017Perez-Zabala et al[8] 2016Saad et al[9] 2011Kakagia et al[10] 2007Driver et al[11] 2006Li et al[12] 2015Saldalam-acchia et al[13] 2004Motolese et al[14] 2015Shan et al[15] 2013Kontopodis et al[16] 2016
PRP spinning approachSingleDoubleSingleDoubleNRSingleDoubleNRSingleSingleSingle
Duration of spin (min)105 and 57NRNR1.54 and 6NR1710NR
CompanyArya Mabna Tashkhis Co, IranNRNRNRBiomet Biologics, Warsaw, IN, United StatesCytomedix, Rockville, MD, United StatesNRNRThermogenesis, Rancho Cordova, CA, United StatesHaemonetics Corp, Braintree, MA, United StatesRegenLab, Le Montsur-Lausanne, Switzerland
PRP activatorCaCl2Thrombin, CaCl2CaCl2Thrombin, CaCl2ThrombinThrombinThrombin, calcium gluconateNRThrombin, CaCl2Thrombin, calcium gluconateNR
PRP amount applied2 mL/cm27 mL3 mLNRNRNRNRNR5 mLNRNR
Platelet concentrationNR1.0 × 106/mL-1.2 × 106/mL1.6-1.7 x baselineNRNRNRNRNRNRNRNR
WBC concentrationNRNRUndetectableNRNRNRNRNRNRNRNR
PRP application methodPRP gel applied on ulcers after irrigation and debridement every week covered with non-absorbing wet dressingPRP gel applied on ulcers after irrigation with 0.9% saline twice weekly covered with non-absorbing dressingPRP gel applied on ulcers after irrigation twice weekly covered with foam dressingsPRP gel applied on ulcers within half an hour after preparation followed by Vaseline gauze and dressing changed every 3-4 dPRP gel applied on ulcers covered with vapor-permeable film (Tegaderm, 3M)PRP gel applied on ulcer with contact layer dressing covered with non-absorbent foam dressing changed every 3-4 dPRP gel applied on ulcer after irrigation and debridement covered with Suile dressing changed every 3 d. PRP gel reapplied up to 5 times in 12 wk period if wound area reduction rate < 80%Weekly topical application of PRP gel with covered with standard dressing changed weekly5 mL of PRP gel applied on ulcers once a week for total of 10 wk covered with non-adherent dressing and bandagePRP gel applied on ulces twice per week covered with occlusive dressing changed every 72 hPRP gel applied on ulcer twice weekly after irrigation and debridement covered with standard dressings
Table 3 Platelet-rich plasma group individual study outcome measures
StudyMohamm-adi et al[6] 2017Ahmed et al[7] 2017Perez-Zabala et al[8] 2016Saad et al[9] 2011Kakagia et al[10] 2007Driver et al[11] 2006Li et al[12] 2015Saldalam-acchia et al[13] 2004Motolese et al[14] 2015Shan et al[15] 2013Kontopodis et al[16] 2016
Ulcer area (mean ± SD, cm2)Baseline6.11 ± 4.376.24 ± 0.910.3NR28.4 ± 13.63.4 ± 4.54.127.3 ± 15.613.914.0 ± 32.34.1 ± 3.9
FinalNR1.44NRNRNRNRNR8.0 ± 7.5NRNRNR
Ulcer healed, n (%)8 wkNR23 (82.1)NRNR2 (11.8)NRNRNRNRNRNR
12 wkNR24 (85.7)NRNRNR13 (68.4)50 (84.8)NRNR15 (71.4)NR
Resvech 2.0 measurementBaselineNRNR13.5 ± 0.7NRNRNRNRNRNRNRNR
FinalNRNR6.0 ± 1.4NRNRNRNRNRNRNRNR
% wound length decreaseNRNRNRNR14.3 ± 7.1NRNRNRNRNRNR
% wound width decreaseNRNRNRNR17.4 ± 8.0NRNRNRNRNRNR
% wound depth decreaseNRNRNRNR34.9 ± 9.9NRNRNRNRNRNR
Time to > 90% ulcer area healing (mean ± SD, wk)8.7 ± 3.9NR7.0 ± 2.811.5NR6.405.1NR12.77.17 ± 5.6611.0 ± 4.0
Healing rate per week (mean, cm2)0.7NR1.46NRNR0.530.8NR1.11.950.37
Adverse effects02 – wound infections0001 – contact dermatitis5 – wound infections0000
Table 4 Average study outcome measures included in best evidence synthesis
Time to > 90% ulcer area healing (mean ± SD, wk)Healing rate per week (mean ± SD, cm2)Adverse effects
PRP7.8 ± 2.70.68 ± 0.568 (2.5)
Control8.3 ± 3.70.39 ± 0.0915 (10.5)
P-value0.115< 0.001< 0.001