Platelet Rich Plasma

PATIENT:  309

Spacecoast Aromedical Institute

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

CASE STUDY          

This 67-year-old female presented to the center for a non-healing ulcer due to large vessel arterial occlusive disease along the right medial leg which had been problematic and progressively getting worse over the past six to eight months.  Her wound care management program up to that point included intermittent debridement, antibiotic therapy, and twice-daily wound care dressing changes.  Nutritional issues had been addressed and the patient demonstrated failure of conventional wound care management strategies.

 PAST MEDICAL HISTORY:  Was significant for a left below-knee amputation secondary to peripheral vascular large arterial occlusive disease.   Her past medical history was also significant for hypertension, coronary artery disease, and hypothyroidism. 

 CURRENT MEDICATIONS:  Included Prilosec, Cardura, Thiazide diuretic and Synthroid.

 SOCIAL HISTORY:  Found no abuse of alcohol or tobacco.

 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:  Included digital photography for serial review.  The wound was irregular with surrounding erythema with moderate granulation tissue formation with significant fibrin deposition. 

 TREATMENT PLAN:  The patient was engaged with 20 hyperbaric oxygen treatments at 2.4 atmospheric, receiving 90 minutes of 100% oxygen.  At the completion of her HBO treatments, the tissue began to granulate and autologous platelet rich plasma was employed twice weekly for two weeks and then once weekly for an additional four weeks.  The wound continued to granulate in a progressive manner and the wound was able to achieve primary closure. 

 COMMENT:  Patients with significant large vessel arterial occlusive disease status post revascularization remain at risk for developing non-healing cutaneous ulcers secondary to poor perfusion.  In this particular case, the patient demonstrated a good clinical response to combination

 HBO therapy and autologous platelet rich plasma tissue grafting.  Given the fact that the wound was approximately nine months in duration justifies aggressive intervention for lower extremity wounds which are at risk for amputation as this patient had undergone a left below-knee amputation five years prior.