Platelet Rich Plasma

PATIENT:  296 

Spacecoast Aromedical Institute

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

CASE STUDY

This 84-year-old male presented to the Center with a large non-healing wound involving the medial left anterior tibialis region which was approximately four months in duration and was not responding to conventional wound care management strategies including twice-daily wound care dressing changes with antibiotic dressings and intermittent debridement status post excision of melanoma with full and complete resection with no evidence of recurrence of tumor.

PAST MEDICAL HISTORY:  Was significant for moderately advanced dementia and hypertension. 

CURRENT MEDICATIONS:  At presentation to the Center included Keflex, Accupril, vitamin E and Aricept. 

SOCIAL HISTORY:  Found the cessation of tobacco in 1964 with no prior history of alcohol abuse.  The patient remains at home but requires supervision due to his moderately advanced state of dementia.

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

WOUND EXAMINATION:  Involving the left anterior tibialis regions was photographed with digital photography for serial review.  The wound was quite deep with poor granulation tissue formation without significant exudative and/or purulent drainage.  Dorsalis pedal pulses were present and capillary refill was brisk.

Cultures were obtained finding no evidence of bacteria but was positive for yeast.  Subsequent cultures and sensitivities demonstrated Candida and Diflucan was initiated at 100 mg two tablets for the first day and then one tablet daily for the following two weeks.  Hyperbaric oxygen therapy was initiated and the patient received 20 treatments of HBO therapy at 2.4 atmospheric pressure. The patient began to demonstrate early signs of granulation and at that point in time autologous platelet rich plasma tissue grafting was initiated twice weekly for the first two weeks and then once weekly for the next six weeks.   The wound demonstrated rapid granulation formation and subsequent epithelialization allowed full primary wound closure with no recurrence. 

COMMENT:  Yeast infections can be seen in problematic non-healing wounds, especially within the elderly.  Wounds which do not respond to appropriate conventional therapy should be cultured carefully for unusual superimposed nonbacterial infections.  The combination of HBO and autologous platelet rich plasma was considered due the gentleman’s advanced age.  Elderly patients typically within the eighth decade are significantly immunocompromised and warrant more aggressive outpatient therapy when conventional wound care management strategies are ineffective.