Platelet-rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections.

Despite the large choice of wide-spectrum antibiotic therapy, deep sternal wound infection (DSWI) following cardiac surgery is a life-threatening complication worldwide. This study evaluated that the use of platelet-rich plasma (PRP) applied inside the sternotomy wound would reduce the effect of sternal wound infections, both superficial and deep. Between January 2007 and January 2012, 1093 consecutive patients underwent cardiac surgery through median sternotomy. Patients were divided into two groups. Group B, the study group, included those who received the PRP applied inside the sternotomy wound before closure. Group A, the control group, included patients who received a median sternotomy but without the application of PRP. Antibiotic prophylaxis remained unchanged across the study and between the two groups. Occurrence of DSWI was significantly higher in group A than in group B [10 of 671 (1·5%) versus 1 of 422 (0·20%), P = 0·043]. Also, superficial sternal wound infections (SSWIs) were significantly higher in group A than in group B [19 of 671 (2·8%) versus 2 of 422 (0·5%), P = 0·006]. The use of PRP can significantly reduce the occurrence of DSWI and SSWI in cardiac surgery.

Adjuvant use of platelet gel for wound breakdown prevention in advanced vulvar cancer surgery: a retrospective study.

OBJECTIVE: The aggressive surgical strategy adopted for vulvar cancer is related to a high complication rate, usually consisting in infections and wound breakdown. Considering that platelet gel concentrate improves reparation of cutaneous lesions, the aim of the current retrospective study was to evaluate the efficacy of platelet gel application in women who had undergone radical surgery for vulvar cancer. MATERIALS AND METHODS: We retrospectively analyzed record charts of 25 women referred to our academic departments with a diagnosis of vulvar cancer and who had undergone radical vulvectomy plus inguinofemoral lymphadenectomy between January 2007 and December 2011. During the reconstructive phase, a platelet gel was placed on the vaginal breach in 10 women (group A). In the remaining 15 patients, only surgical strategies were performed (group B). Primary outcomes were wound infection, necrosis, and/or breakdown of wounds rates; secondary outcomes were postoperative fever, hospital stay, and lastly, wound healing. RESULTS: Compared to surgery alone, the platelet gel application was related to a significant decrease in wound infection (P = 0.032), necrosis of vaginal wounds (P = 0.096), and breakdown wound (P = 0.048) rates. In addition, in group A, reduction in postoperative fever rate (P < 0.001) and hospital stay (P < 0.001) were also detected. Compared to surgery alone, a faster wound healing in patients who had undergone surgery plus platelet (P < 0.001) were lastly observed. CONCLUSION: In conclusion, platelet gel application before vulvar reconstruction represents an effective strategy to prevent wound breakdown after local advanced vulvar cancer surgery. However, further prospective data are needed to confirm these preliminary results.

Application of platelet-rich gel to enhance healing of transmetatarsal amputations in diabetic dysvascular patients.

Transmetatarsal amputation (TMA) represents an effective surgical procedure used to treat several clinical conditions such as forefoot infection, gangrene and chronic ulceration in diabetic patients. TMA permits walking without the need for prosthesis, but nevertheless is burdened with a high complications rate. The aim of this study was to evaluate the possibility to use platelet gel (PG) as an adjuvant therapy when performing TMA procedure in diabetic patients. In a 6-year period, 26 diabetic patients had undergone TMA procedure followed by autologous PG applications (group A) and 32 patients had undergone TMA as sole procedure (group B). After TMA procedure, the treatment is based on outpatient management and consists of a weekly platelet-rich plasma gel application on the surgical wound for 1 month in group A and on clinical evaluation only for group B. For group A, healing rate was of 96.15% and one patient (3.84%) presented wound dehiscence, and no postoperative wound infections occurred. For group B, healing rate was of 59.37%; severe infection of the stump prompted to the proximal amputations in 40.62% of patients during the follow-up period. PG application may be an effective adjuvant treatment to improve wound healing in diabetic dysvascular patients.

Reuse of MSWI bottom ash mixed with natural sodium bentonite as landfill cover material.

The research described in this study had the aim of evaluating the reuse of incinerator slag, mixed with sodium bentonite, for landfill capping system components. A characterization was performed on pure bottom ash (BA) samples from an incinerator in the north of Italy. The results show that the BA samples had appropriate properties as covers. The compacted dry unit weight of the studied BA (16.2 kN m(-3)) was lower than the average value that characterizes most conventional fill materials and this can be considered advantageous for landfill cover systems, since the fill has to be placed on low bearing capacity ground or where long-term settlement is possible. Moreover, direct shear tests showed a friction angle of 43°, corresponding to excellent mechanical characteristics that can be considered an advantage against failure. The hydraulic conductivity tests indicated a steady-state value of 8 × 10(-10) m s(-1) for a mixture characterized by a bentonite content by weight of 10%, which was a factor 10 better than required by Italian legislation on landfill covers. The results from a swell index test indicated that fine bentonite swelled, even when divalent cations were released by the BA. The leaching behaviour of the mixture did not show any contamination issues and was far better than obtained for the pure BA. Thus, the BA-bentonite mixture qualified as a suitable material for landfill cover in Italy. Moreover, owing to the low release of toxic compounds, the proposed cover system would have no effect on the leachate quality in the landfill.

Autologous platelet-rich plasma in the treatment of refractory corneal ulcers: A case report.

PURPOSE: To evaluate the efficacy of a low-cost preparation of platelet-rich plasma (PRP) eye drops in the treatment of persistent non-infectious corneal ulcer. OBSERVATIONS: A 67-year-old female presented to our clinic with a wide corneal ulcer and severe paracentral corneal thinning refractory to medical therapy with antibiotics, lubricant and contact lens bandage. The patient received a novel preparation of PRP solution. After 15 days of therapy, we observed complete resolution of the corneal ulcer with regrowth of the epithelium and a reduction in corneal opacity. CONCLUSION AND IMPORTANCE: Although the low-cost PRP preparation gives a lower platelet concentration than standard procedures, our work shows this preparation to be effective in the treatment of refractory non-infectious corneal ulcer.

Ventricular assist device driveline infection: treatment with platelet-rich plasma.

We report a case of autologous platelet-rich plasma (PRP) application over the driveline site of a left ventricular assist device (LVAD) to treat an infection. The patient, a 47-year-old man with end-stage dilated cardiomyopathy, underwent Jarvik 2000 implantation through a median sternotomy. A pedestal with power supply and LVAD control was implanted into the mastoid bone. Retroauricular wound dehiscence occurred, and PRP was applied over the wound. Normal healing of the driveline exit site was observed. PRP can be used at a driveline exit site to either prevent or treat wound infection.

Platelet gel in oral and maxillofacial surgery: a single-centre experience.

BACKGROUND: Platelet gel is a blood product intended for non-transfusion, therapeutic purposes; it is produced by combining platelet concentrate with cryoprecipitate. Platelet gel stimulates tissue growth and is a key player in tissue regeneration. As an allogeneic product, platelet gel is obtained from the blood of a common type O blood donor, with a platelet count >200×10(3)/µL. Most of the beneficial effects of this product are due to the numerous growth factors (PDGF, TGF-ß, IGF-1 and IGF-2, EGF, VEGF and FGF) contained in the alpha-granules of platelets. The aim of this study was to confirm that platelet gel is a valuable aid for the surgical repair of alveolar bone loss. MATERIALS AND METHODS: Our study was carried out on 87 patients with inflammatory or dysembryoplastic osteolytic lesions >2 cm in diameter in jaw bones. For most patients the platelet gel was collected into a 450 mL bag and kept frozen at -40 °C until, whereas for a small group of patients the gel was prepared and activated in the sterile field of the operating theatre. RESULTS: All of our patients reported a decrease in painful symptoms immediately after surgery. Follow-up showed considerable acceleration of the healing processes in soft tissues and faster bone regeneration. CONCLUSION: Multicentre studies are needed in order to standardise the methods for producing platelet gel and the clinical use of this product. Furthermore, for research purposes in vitro studies are needed to increase knowledge on the functional network and platelet growth factors and also to investigate the biochemical and molecular mechanisms involved.