L-PRF in chronic wounds
Introduction
The main goal in wound care is to close the wound as quickly as possible to avoid complications and improve the patient's quality of life. To help wounds heal, we need to: (a) identify why the wound happened, improve the person's general health, and manage any infection or inflammation; (b) clean the wound and remove dead tissue, foreign objects, and any fluids or films that might be present; and (c) use the right wound dressing (to control fluid levels and keep the wound moist). Leukocyte- and Platelet-Rich Fibrin (L-PRF) membranes are useful in wound healing because they (a) act as a good barrier for the wound, (b) have antibacterial and pain-relieving properties, and (c) release growth factors that help repair tissues and form new blood vessels. L-PRF has proven to be beneficial in chronic wounds (e.g., diabetic foot) as well as in surgical (fresh) wounds and burns.
Simple explanation of wound care with L-PRF
For the application of L-PRF following steps are taken:
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The wound is cleaned with a saline solution or wound cleanser to gently wash away any fluids.
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The wound and surrounding area are disinfected with a disinfectant.
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A debridement will remove dead tissue and debris.
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Sometimes a liquid film-forming spray is applied around the wound to prevent skin damage.
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Small bleeding points are created to help the L-PRF membranes stick to the wound and supply them.
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L-PRF membranes are applied to the wound.
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They are covered with a special non-sticking primary dressing that should stay in place for 7 days.
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This primary dressing is covered with a plastic film to keep the wound moist and protect it from drying out and from external contaminants.
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Finally, a last dressing is applied to absorb fluids. This dressing can be changed as needed without disturbing the wound underneath.
This treatment is repeated every week or every two weeks, following the same steps each time, except for the debridement. Loose L-PRF membranes, dead tissue, and debris have to be removed, but membranes that are attached to the wound or becoming new tissue should remain.
"Further down, you will see clinical images of different cases. These images might be shocking and are not suitable for sensitive individuals, even though the most bloody parts have been partially hidden."
information for your healthcare providers
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Diabetic foot ulcer (DFU)
initial wound area
A very large and deep diabetic foot ulcer (DFU) didn't heal for months despite regular surgery and cleaning. After applying L-PRF membranes weekly for 8 weeks (using 16 L-PRF membranes for the first treatment to cover the whole wound), the wound completely closed. The picture on the right shows the healed wound one year later, with no signs of the ulcer coming back. The patient, of course, needed to follow all recommendations for optimal health. (The dotted red line shows the initial size of the wound).
Venous leg ulcer (VLU)
initial wound area
This patient had a very large venous leg ulcer (occurring when the veins in a leg do not push the blood back up to the heart efficiently) that didn't heal for over 10 years with regular treatment. Weekly applications of L-PRF membranes were started, and after 6 weeks, the wound was almost closed. L-PRF therapy was no longer needed, but the patient had to do some aftercare. Additionally, he had to follow the general health advice strictly, and factors causing the ulcer need to be avoided to prevent recurrence. (The dotted red line shows the initial size of the wound).
Complex chronic ulcer
initial wound area
This patient had a 10 cm wound on the back of her lower leg. She had a complex medical condition involving diabetes and venous and arterial complications. Despite advanced care, the wound didn't heal, and the patient needed a wheelchair. An amputation of the leg was suggested, but she refused. The wound was finally treated with L-PRF (Leukocyte and Platelet-Rich Fibrin) membranes. Even though some bone and muscle were exposed, the wound closed completely after 10 months of regular L-PRF applications (weekly, and later every two weeks). The wound stayed healthy for over 3.5 years, as shown in the right picture. (The dotted red line shows the initial size of the wound).
Burns
A dental technician burned her fingers while making a crown in wax. The burn wounds were treated with L-PRF. It was important for her that scar formation was minimized. The healing process went very well, as seen in the photo taken after eight weeks. Scar formation could be prevented, and she retained perfect flexibility in her hands, allowing her to continue her profession without any hindrance.
General observations made in clinical trials
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In most patients, the ulcer had been present for weeks/months/years and didn't heal with regular treatments. Using L-PRF membranes weekly healed almost all chronic wounds.
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Adverse effects were extremely rare.
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The healing time depends on the wound size; bigger wounds need more L-PRF applications.
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It's important to evaluate and improve the patient's overall health (including an assessment of underlying systemic conditions, medication, nutrition, etc.) before starting L-PRF therapy to ensure success and prevent recurrence.