L-PRF in surgical wounds
Introduction
Wound healing is a complex and dynamic process involving various biological and molecular events, including hemostasis, inflammation, proliferation, and tissue remodeling/maturation. These events are regulated by a diverse range of cells and soluble biomarkers, such as growth factors and cytokines. While both dermal and oral mucosal wound healing proceed through the same phases, dermal wounds typically heal more slowly and often result in scar formation.
Recent research has increasingly explored the potential of autologous platelet concentrates (Perussolo et al. 2025, Pinto et al. 2025), particularly leukocyte- and platelet-rich fibrin (L-PRF), in extra-oral wound care. Due to its high concentration of platelets, leukocytes, and growth factors, L-PRF shows promise as an alternative or adjunctive therapy to conventional treatments for various surgical wounds, leading to accelerated healing and improved patient-reported outcome measures (PROMs).
Protocol: step by step
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gently clean the wound through irrigation using a standard saline solution or wound cleanser to remove all exudate,
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eventually inject L-PRF exudate into the wound area and its periphery,
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apply L-PRF membranes to the wound bed,
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cover the wound and surrounding borders with a "non-adhering" knitted primary dressing (e.g., Adaptic touch, Mepitel One). Optionally, use a plastic film to ensure a moist environment and prevent dehydration of the L-PRF membranes,
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apply a dry dressing to capture the wound exudate; this dressing can be changed as needed (e.g., to absorb additional exudate and avoid unpleasant odors) without disturbing the wound dressing underneath.
Cases
1: Fresh cut
A man cut part of his finger in the kitchen. L-PRF was applied, followed by a non-adhering knitted primary dressing and dry dressing. This treatment was repeated weekly, and 4 weeks later the wound was nearly completely regenerated. Several weeks later, a healthy soft-tissue had formed without any scar formation.
Courtesy: Yannick Spaey
2: Non-healing donor site for pediculated graft
Courtesy: Nelson Pinto
A large, non-healing wound developed following the preparation of a pediculated flap for the reconstruction of an eye socket post-enucleation. The wound showed no improvement over a period of three months. After superficial debridement, L-PRF membranes were applied. One week later, the formation of healthy granulation tissue was evident. Subsequent images taken at 3, and 7 weeks demonstrated a reduction in wound size, ultimately leading to complete wound closure and even some new hair growth.
3: Large wound after excision of a malignant tumor (cheek)
Following the resection of a malignant skin tumor, a significant skin wound was created. The entire area was covered with L-PRF membranes, without the use of any additional tissue grafts. These membranes were replaced on a weekly basis. After six weeks, the wound was completely closed, and no further treatment was necessary. Upon close examination, optimal healing was observed, without scar tissue and the presence of new hair growth.
Courtesy: Diego Pinto
4: Non-healing postoperative ulcer (trauma surgery)
d 0: A 47-year-old female patient presented with a postoperative ulcer (trauma surgery) in the right malleolar area (2x1.5 cm²) with low microbial colonization, persisting for 12 weeks without improvement despite conventional wound care. One L-PRF membrane was applied weekly, covered with Adaptic and gauzed. d 7: the wound exhibited 100% granulation tissue; subsequently, only the face part of the L-PRF membrane was applied. d 14 the wound was completely epithelialized.
Courtesy: Catalina Carvajal Contreras
5: Laceration of the right leg sustained from a bicycle fall
d 0: a 33-year-old male patient presented with a 5x2 cm² laceration with critical colonization in the midsection of the right leg from a bicycle fall. Despite three weeks of advanced wound care, the wound bed condition worsened. L-PRF membranes were applied weekly. d 8: after one application, the wound showed 95% granulation tissue and 5% sloughed tissue. d 15: the wound reduced to 3.7x1 cm² and was 100% filled with granulation tissue. L-PRF membranes were reapplied.
d 21: 85% epithelialization was observed. L-PRF was reapplied, and the patient decided not to attend further sessions, believing the wound would continue to heal. d 28: he sent a photo showing 95% epithelialization.
Courtesy: Catalina Carvajal Contreras
6: post-surgical wound (patello-femoral realignment)
d 0: a post-surgical knee wound (3x2 cm², 0.1 cm deep) critically colonized and exuding abundant exudate; after 5 months of conventional treatment with no progress, 3 L-PRF membranes were applied, covered with Adaptic gauze, and an absorbent dressing. d 7: 90% granulation tissue, 10% sloughed tissue; the wound size reduced to 2.5x1.5 cm², and the depth disappeared. Only one L-PRF membrane used. d 14: little exudate, 100% granulation tissue, and a wound size of 1.5x1 cm². d 21: 100% and d 42 completely epithelialization.
Courtesy: Catalina Carvajal Contreras
7: Large skull lesion after tumor resection
An elderly male patient was diagnosed with a large dermatofibrosarcoma. Due to his medical condition, a minimally invasive intervention under IV sedation was performed. Following tumor excision, the cranial defect was filled exclusively with 16 L-PRF membranes, resulting in uneventful healing. A photograph taken 1.5 years later shows a normal appearance of the skull.
Courtesy: Yannick Spaey
8: Patient with an active oncological hematological issue
An elderly male patient with polycytemia vera treated with een JAK inhibitor presented with a large squamous cell carcinoma of the scalp. Resection with clear margins was obtained with 3D histological confirmation leaving a large scalp defect. Since the patiënt was not fit for major surgery, this defect was managed through the weekly application of L-PRF membranes. Photographs were taken at the initial presentation, at 2 weeks, and subsequently at 4, 6 (including the L-PRF application), 10, 12, 15, 18, 21, and 24 weeks. Over time, the formation of granulation tissue was clearly evident, with complete wound closure achieved after 24 weeks.
Courtesy: Michiel Bonny
9: Large scalp wound after trauma
A large frontal scalp wound with significant tissue loss (measuring 5.3 by 5.4 cm), overlying crusts, and pus discharge from the lower part was observed. Both the trigeminal and facial nerves remained functional. After debridement, the periosteum remained intact, although the cranial part of the temporalis muscle was lost. Seven L-PRF membranes were applied to the wound bed. After 3 weekly applications of L-PRF, the wound was completely filled with granulation tissue. From week 4 onwards, the wound was only cleaned and covered with an Isobetadine Tule Kompres. By week 6, the wound had reduced to 2.5 by 1.9 cm, and the Isobetadine treatment was continued. The last picture is a follow-up image taken 1 year later.
Courtesy: Yannick Spaey
Data:
Most relevant clinical trials on the impact of L-PRF on surgical wounds
Abbreviations: Study type: RCT = randomized controlled trial, p/rS = prospective/retrospective study, CR = case report, d = day, w = week, m = month, y = year. Centrifugation data: device, rpm = revolutions/rotations per minute, g = g-force; min. = minutes. Intervention: R/ = treatment, C = control, T = test, L-PRF m = L-PRF membrane / cl = clot / pl = plug / ex = exudate, STSG = split-thickness skin graft. Outcome:, AE = adverse events, discont’d = discontinued, CSF = cerebrospinal fluid, CR = complete resolution, > = increased, = = similar.
Conclusion:
For most interventions, the application of L-PRF often resulted in improved outcomes for both the wound healing process as well as for the patient reported outcome measures.
Important notice
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The number of papers for the different indications of L-PRF in surgical wounds is rather small, and insufficient to make strong treatment recommendations or clear statements.
Interesting references
Several videos and/or cases on this webpage are discussed more in detail in the following book: Quirynen M & Pinto N 2022. Leukocyte- and Platelet-Rich Fibrin in Oral Regenerative Procedures. Quintessence Publishing;
ISBN: 978-1-78698-105-9