Platelet Rich Plasma

PATIENT:  151 

Spacecoast Aromedical Institute

Dr. Paul W. Buza, DO, ACN, AME

CASE STUDY

This 72-year-old male presented to the Wound Care Center with a large non-healing diabetic ulcer involving the dorsum of the right foot with multiple bone exposure and was being considered for full-thickness skin graft.  Digital photography is available for review of his initial presentation. 

PAST MEDICAL HISTORY:  Was significant for insulin-dependent diabetes, peripheral vascular arterial disease status post revascularization and history of prostate cancer status post radiation therapy. 

PAST SURGICAL HISTORY:  Appendectomy, cardiac pacemaker placement, and prostatectomy.

CURRENT MEDICATIONS:  Included insulin, Norvasc, nortriptyline, Trental, Lanoxin, Zestril, Prevacid, and Plavix.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  Of the mid dorsum of the foot revealed a large non-healing ulcer with multiple bone exposure with poor granulation tissue formation without exudative and/or purulent drainage.  Dorsalis pedal pulses were intact.  Capillary refill was brisk. 

TREATMENT PLAN:  A course of 20 hyperbaric oxygen treatments beginning at 2.4 atmospheric, receiving 90 minutes of 100% oxygen was initiated in addition to conventional wound care management strategies including twice-daily wound care dressing changes with wet-to-dry dressings.  During his course of therapy, he demonstrated no evidence of local infection.

 At the completion of his course of HBO therapy, autologous platelet rich plasma grafting commenced twice weekly for the first three weeks and then once weekly thereafter.  (Please review digital photography for serial review demonstrating the ability for granulation tissue and migration over exposed metatarsal bone.)

 At this point in time, a decision was made to cancel full-thickness skin grafting and the patient has been doing well with appropriate follow-up for foot care and addressing the issues of biomechanical orthotics with appropriate footwear.

COMMENT:  Bone exposure in the distal lower extremity indicates poor prognosis for primary granulation tissue closure.  Typically, these patients are scheduled for full-thickness skin graft due to the inability of the distal lower extremity to mount sufficient angiogenesis and granulation tissue for primary closure.   Of note in this particular case is the achievement of his primary closure with nonsurgical intervention as a result of the combination of HBO therapy and autologous platelet rich plasma treatment plan.