Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2018; 9(10): 172-179
Published online Oct 15, 2018. doi: 10.4239/wjd.v9.i10.172
Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review
Takashi Hirase, Eric Ruff, Salim Surani, Iqbal Ratnani
Takashi Hirase, Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX 77030, United States
Eric Ruff, Department of Plastic and Reconstructive Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
Salim Surani, Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Corpus Christi, TX 77807, United States
Iqbal Ratnani, Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX 77030, United States
Author contributions: Hirase T and Ruff E designed the research; Hirase T and Ruff E performed the research; Hirase T analyzed the data; Hirase T and Ruff E wrote the paper; Surani S and Ratnani I supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salim Surani, FACC, FACP, MD, Adjunct Clinical Professor, Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, 701 Ayers street, Corpus Christi, TX 77807, United States. srsurani@hotmail.com
Telephone: +1-361-8857722 Fax: +1-361-8857792
Received: May 2, 2018
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
Processing time: 163 Days and 18.7 Hours
Abstract
AIM

To determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates.

METHODS

A systematic 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 including: 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. Study heterogeneity and a mostly non-comparative nature of evidence precluded meta-analysis. Only the outcome measurements used by more than 50% of the studies were included in the data synthesis to increase power of the measurement over that of individual studies. A weighted mean of healing rate per week between PRP group vs controls were compared using two-sample z-tests using P-value of less than 0.05 for significance.

RESULTS

One thousand two hundred and seventeen articles were screened. Eleven articles (322 PRP subjects, 126 controls, PRP subject mean age 58.4 ± 7.2 years, control mean age 58.7 ± 5.9 years) 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 was 7.8 ± 2.7 wk and 8.3 ± 3.7 wk for patients in the PRP group and control groups, respectively (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).

CONCLUSION

The topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls.

Keywords: Platelet rich plasma; Diabetes; Foot; Ulcer; Wound

Core tip: There is growing evidence supporting the use of autologous platelet-rich plasma (PRP) to enhance the healing process of diabetic foot ulcers (DFUs). This systematic review of eleven articles (322 PRP subjects, 126 controls) showed that 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). There were significantly lower adverse effects reported with PRP application compared to controls. The authors conclude that the topical application of PRP for DFUs results in statistically superior healing rates compared to controls with lower complication rates.