Platelet Rich Plasma

PATIENT:  333

Spacecoast Aromedical Institute

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

CASE STUDY          

This 81-year-old female presented to the center with a left medial leg ulcer of five months in duration refractory to appropriate wound care management strategies which included twice-daily wound care dressing changes, intermittent debridement, and appropriate antibiotics for local infection. 

PAST MEDICAL HISTORY:  Was significant for hypertension, transient ischemic attack, and hypothyroidism as well as remote breast malignancy status post mastectomy over 20 years prior.  She also had gout.

CURRENT MEDICATIONS:  Aldactazide, allopurinol, Catapres, Cozaar, Ecotrin, Prilosec, Synthroid, and Zyrtec. 

FAMILY HISTORY:  Was unremarkable.

SOCIAL HISTORY:  Found no prior abuse of tobacco, alcohol or illicit drugs.  She is a physically active retiree who exercises frequently and has appropriate nutritional intake. 

ALLERGIES:  SULFA-BASED MEDICATIONS.

PHYSICAL EXAMINATION:  Vital signs were stable.  The patient was afebrile.  Ear, nose, and throat examination was unremarkable.  The heart was regular in rate and rhythm.  Lungs were clear to auscultation.

WOUND EXAMINATION:  Of the left leg wound found a circumferential wound with poor granulation tissue involvement with relative avascular margins without associated calf edema.  Dorsalis pedal pulses were intact.  Digital photography was obtained for serial review.

The patient’s treatment consisted of platelet-rich plasma autologous grafting, twice weekly for two weeks and then once weekly for a total of five treatments demonstrating significant induction of granulation tissue and the patient was able to achieve complete healing with good tensile strength.

COMMENT:  Patients in their eighth decade who have non-healing wounds involving the lower extremities are typically very challenging to treat.  Their ability for granulation tissue formation appears to be inhibited despite the absence of other immunocompromised states including concomitant peripheral vascular disease and/or diabetes.  Given the fact that the patient was in her eighth decade and appropriate wound care management strategies had been employed and the patient was very compliant otherwise, aggressive growth factor therapy was initiated with good results.