Long-Term Outcome of Photobiomodulation Therapy for Refractory Diabetic Wound After Secretory Carcinoma of the Parotid Gland Surgery: A Case Report.

Objective: To evaluate the efficacy and safety of photobiomodulation therapy (PBMT) in the treatment of diabetic patients with refractory wound. Background: Refractory wound is one of the most challenging clinical complications of diabetes mellitus. Studies have shown that PBMT can promote wound healing in many ways. Methods: We reported a 55-year-old male patient with refractory diabetic wound after secretory carcinoma of the parotid gland surgery responding to 810 nm laser. Results: After PBMT, the refractory diabetic wound healed gradually without adverse events. During follow-up 5-years, the healed wound remained stable and showed no signs of recurrence. Conclusions: PBMT can be potentially considered as a therapeutic method in diabetic patients with refractory diabetic wound.

Clinical observation of ultraviolet therapy combined with autologous platelet-rich plasma in the treatment of chronic refractory wounds.

Refractory wounds present complex and serious clinical dilemmas in plastic and reconstructive surgeries. Currently, there are no standard guidelines for the treatment of refractory wounds. To observe the clinical effects of ultraviolet (UV) therapy combined with autologous platelet-rich plasma (PRP) on chronic refractory wounds. Between January 2021 and December 2022, 60 inpatients with chronic refractory wounds were enrolled. Twenty patients were assigned to each of control groups 1 and 2 and treatment group according to whether they received PRP or UV treatment. All the patients underwent thorough debridement. Control group 2 received UV radiation. The treatment group underwent UV radiation combined with PRP gel covering the wound. Control group 1 underwent routine dressing changes after surgery, followed by skin grafting or skin key transfer if needed. One month later, we observed the wound healing in the two groups. After 2-4 PRP gel treatments, the wounds of patients in the treatment group healed. The healing time was 25.25 ± 4.93 days, and the dressings were changed 4.15 ± 3.30 times, both of which were better outcomes than in both control groups. In the treatment group, epidermal growth factor (EGF), insulin-like growth factor (IGF), platelet-derived growth factor (PGF), and transforming growth factor ß (TGF-ß) were slightly higher, and the concentration of vascular endothelial growth factor (VEGF) was significantly higher than in the control group (p < 0.05). PRP combined with UV therapy significantly increased the concentration of wound growth factors, accelerated wound healing, shortened treatment time, reduced treatment costs, and alleviated pain in patients.

Mechanism of Promoting Chronic Refractory Wound Repair by Polysaccharides in Traditional Chinese Medicine： A Review / 中国实验方剂学杂志

A chronic refractory wound is caused by continuous skin damage. At the same time， it may be formed due to repeated infection， vascular insufficiency， diabetes， tumors， chronic osteomyelitis， and other reasons， resulting in wound repair interruption and recovery delay. Chronic refractory wound seriously affects the quality of life of patients and consumes a lot of medical resources. Polysaccharides in traditional Chinese medicine （TCM） are the effective components of most TCM. Modern pharmacological studies have found that polysaccharides contained in TCM have anti-inflammatory， antioxidant， anti-radiation， hypoglycemic， antiviral， anti-tumor， hypolipidemic， and immunomodulatory effects. Through the summary and analysis of the literature， it was found that the mechanism of polysaccharides in TCM to promote chonic refractory wound repair was mainly realized from the following aspects： firstly， regulating inflammatory cytokines like interleukin-4 （IL-4）， interleukin-10 （IL-10）， interleukin-8 （IL-8）， and tumor necrosis factor-α （TNF-α） or regulating macrophage-related inflammatory proteins and chemotactic proteins like MIP-2， MCP-1， to shorten the inflammatory period. Secondly， activating growth factors like platelet-derived growth fator （PDGF）， basic fibroblast growth factor （bFGF）， TGF-α， and vascular endothelial growth factor （VEGF） to recruit endothelial cells and fibroblasts into tissue proliferation. Thirdly， activationg VEGF and its downstream receptor vascular endothelial growth factor receptor-1 （VEGFR-1） and vascular endothelial growth factor receptor-2 （VEGFR-2）-mediatated protein kinase C/extracellular regulated kinases （PKC/ERK） signaling pathway or promoting angiogenesie and improving wound blood flow through angiotensin （ANG）. Fourthly， promoting the ablility of collagen synthesis by enhancing the secretion of hydroxyproline and hyaluronic acid （HA） from fibroblasts （FB） and regulating relevant matrix metalloenzymes and their enzyme inhibitor to regulate the extracellular matrix. Fifthly， eliminating free radiccals to reduce the damage caused by oxidative stress to tissue. Sixthly， enhancing the phagocytic ability of macrophages， the activity of natural killer cells， and the proliferation of T cells to improve the defense ability of tissue. Polysaccharides in TCM can repair wounds in many ways at the same time. Its advantage lies in the multiple targets and multiple pathways. It is expected that the research will pay more attention to the mechanism of wound repair by polysaccharide components in TCM when improving the treatment of chronic refractory wounds.

Factors influencing allogeneic platelet concentrate in chronic refractory wounds / 中国组织工程研究

BACKGROUND:Clinical application of autologous platelet-rich plasma is limited by the condition of patients and by the quantity and activity of platelets.Transfusable platelet component blood platelet concentrates,collected and prepared by blood collection and supply agencies,are widely available,can be standardized and are effective in the clinic. OBJECTIVE:To review the factors influencing the preparation of platelet concentrate by the buffy-coat method for the treatment of chronic refractory wounds. METHODS:A computer search of the PubMed,CNKI,and WanFang databases for platelet-related articles from January 2000 to April 2023 was conducted using the Chinese and English search terms"allogeneic platelets(concentrate),buffy-coat method,skin ulcer,refractory wounds".The titles and abstracts were screened,and the full text was reviewed,resulting in the inclusion of 51 articles that met the subject criteria. RESULTS AND CONCLUSION:(1)Platelet concentrates supplied by blood collection and supply agencies are effective in the treatment of diabetic foot wounds,pressure sores,lower limb venous ulcers and other chronic refractory wounds:reducing the size of the ulcer and shortening the wound healing time,especially in the first two weeks,with significant healing-promoting effects.(2)The storage conditions of the raw material used to prepare platelet concentrates(whole blood overnight/buffy-coat overnight,shaking/resting(time)),centrifugation conditions(centrifugation parameters,canning method)and the structure of the blood bag can affect the concentration of platelet concentrates,indirectly affecting the efficacy of allogeneic platelet concentrates.(3)There are also some problems with studies of allogeneic platelet concentrates for the treatment of chronic refractory wounds,such as the sample size of the available evidence is small,the results lack the optimal preparation parameters,optimal dose and treatment regimen for platelet concentrates to promote healing of different wounds are unknown,so more randomized multicenter clinical studies are needed.

A Novel Comprehensive Therapeutic Approach to the Challenges of Chronic Wounds: A Brief Review and Clinical Experience Report.

Following the clinical perspective and concept that a healthy body will not develop chronic wounds, the central approach for the treatment described here is based on an understanding of how the body transforms the wound microenvironment from a non-healing to a healing state. As part of a comprehensive treatment regimen that includes OCM™ (complete matrix), wound preparation, and skin protectant formulations, the OCM contains components for complete wound healing by attending to the individual needs required to promote the closure of each unique chronic wound. During application of the comprehensive treatment regimen in independent investigator-led trials, the total wound percentage average reduction over the first 4 weeks of treatment was 60% across multiple wound types; median time to total wound closure was 6.9 weeks. Safety testing of the OCM formulation shows no potential allergenicity, no potential sensitization, and no known product-related adverse events. Clinical trials evaluating the OCM formulation as part of the comprehensive treatment regimen of multiple wound types are underway. Results of clinical trials and real-world experiences will expand current knowledge of the wound-healing potential of this novel product.

Extracellular vesicles modulate key signalling pathways in refractory wound healing.

Chronic wounds are wounds that cannot heal properly due to various factors, such as underlying diseases, infection or reinjury, and improper healing of skin wounds and ulcers can cause a serious economic burden. Numerous studies have shown that extracellular vesicles (EVs) derived from stem/progenitor cells promote wound healing, reduce scar formation and have significant advantages over traditional treatment methods. EVs are membranous particles that carry various bioactive molecules from their cellular origins, such as cytokines, nucleic acids, enzymes, lipids and proteins. EVs can mediate cell-to-cell communication and modulate various physiological processes, such as cell differentiation, angiogenesis, immune response and tissue remodelling. In this review, we summarize the recent advances in EV-based wound healing, focusing on the signalling pathways that are regulated by EVs and their cargos. We discuss how EVs derived from different types of stem/progenitor cells can promote wound healing and reduce scar formation by modulating the Wnt/ß-catenin, phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin, vascular endothelial growth factor, transforming growth factor ß and JAK-STAT pathways. Moreover, we also highlight the challenges and opportunities for engineering or modifying EVs to enhance their efficacy and specificity for wound healing.

Mini-Review: Tendon-Exposed Wound Treatments.

BACKGROUND: Tendon-exposed wounds are complex injuries with challenging reconstructions and no unified treatment mode. Furthermore, insufficient tissue volume and blood circulation disorders affect healing, which increases pain for the patient and affects their families and caretakers. REVIEW: As modern medicine advances, considerable progress has been made in understanding and treating tendon-exposed wounds, and current research encompasses both macro-and micro-studies. Additionally, new treatment methods have emerged alongside the classic surgical methods, such as new dressing therapies, vacuum sealing drainage combination therapy, platelet-rich plasma therapy, and live-cell bioengineering. CONCLUSIONS: This review summarizes the latest treatment methods for tendon-exposed wounds to provide ideas and improve their treatment.

Application of double-tube negative pressure drainage in repair of refractory wounds.

OBJECTIVE: To observe the application effect of double-tube negative pressure drainage in the repair of refractory wounds. METHODS: From January 2020 to April 2023, 50 patients undergoing refractory wound repair in the Department of Burn and Plastic Surgery of Jingjiang People's Hospital, Jiangsu were selected. According to different treatment methods, they were divided into an observation group and a control group, with 25 patients in each group. The observation group was treated with double-tube negative pressure drainage inside and outside the wound, while the control group was treated with negative pressure drainage inside the wound. By two-week observation, the wound healing status and complication rate after treatment, as well as the wound bacterial clearance rate, wound pain score and patient satisfaction 3, 7 and 14 d after treatment were compared between the two groups. Statistical analysis was carried out to determine the efficacy. RESULTS: After treatment for two weeks, the observation group showed a higher grade A healing rate (92% vs. 60%, X2  = 7.018, P = 0.008), a higher wound bacterial clearance rate (100% vs. 76%, X2  = 6.818, P = 0.03), a lower pain score (1.44 ± 0.51 vs. 2.36 ± 0.49, t = -6.53, P < 0.01), a higher patient satisfaction score (8.48 ± 0.96 vs. 6.64 ± 0.95, t = 6.80, P < 0.01), and a lower complication rate (8% vs. 40%, X2 = 7.018, P = 0.008) compared with the control group. CONCLUSION: Double-tube negative pressure drainage has a significant application effect in the repair of refractory wounds. It can accelerate wound healing, shorten treatment time, effectively eliminate bacteria, relieve wound infection, reduce complications, alleviate pain and improve patient satisfaction. Therefore, the application, promotion and research of double-tube negative pressure drainage should be strengthened in clinical practice.

Rab37 Promotes Endothelial Differentiation and Accelerates ADSC-Mediated Diabetic Wound Healing through Regulating Secretion of Hsp90α and TIMP1.

Accumulating evidence indicates that adipose tissue-derived mesenchymal stem cells (ADSCs) are an effective treatment for diabetic refractory wounds. However, the application of ADSCs to diabetic wounds is still limited, indicating that we still lack sufficient knowledge regarding regulators/mediators of ADSCs during wound healing. Rab37, a member of RabGTPase, may function as regulator of vesicle trafficking, which is a crucial event for the secretion of cytokines by ADSCs. Our previous study indicated that Rab37 promotes the adiopogenic differentiation of ADSCs. In this study, we explored the role of Rab37 in ADSC-mediated diabetic wound healing. An in vivo study in db/db diabetic mice showed that Rab37-expressing ADSCs shortened the wound closure time, improved re-epithelialization and collagen deposition, and promoted angiogenesis during wound healing. An in vitro study showed that Rab37 promoted the proliferation, migration and endothelial differentiation of ADSCs. LC-MS/MS analysis identified Hsp90α and TIMP1 as up-regulated cytokines in conditioned media of Rab37-ADSCs. The up-regulation of Rab37 enhanced the secretion of Hsp90α and TIMP1 during endothelial differentiation and under high-glucose exposure. Interestingly, Rab37 promoted the expression of TIMP1, but not Hsp90α, during endothelial differentiation. PLA showed that Rab37 can directly bind to Hsp90α orTIMP1 in ADSCs. Moreover, Hsp90α and TIMP1 knockdown compromised the promoting effects of Rab37 on the proliferation, migration and endothelial differentiation of ADSCs. In conclusion, Rab37 promotes the proliferation, migration and endothelial differentiation of ADSCs and accelerates ADSC-mediated diabetic wound healing through regulating the secretion of Hsp90α and TIMP1.

Autologous wound margin point columnar full-thickness skin grafting combined with negative pressure wound therapy improves wound healing in refractory diabetic foot ulcers.

Diabetic lower extremity ulcers (DLEUs) are a severe complication of diabetes mellitus (DM) and are difficult to heal. This study aimed to explore the efficacy of autologous point columnar full-thickness skin graft taken from the ulcer wound margin combined with negative pressure wound therapy (NPWT) in refractory DLEUs. This is a prospective cohort study. A total of 40 inpatients with refractory DLEUs were recruited in the Diabetes Foot Center of Guangxi Zhuang Autonomous Region People's Hospital from October 2019 to November 2021. According to the doctors' professional suggestions and the patients' personal wishes, these enrolled patients were divided into two groups based on different topical wound management: the graft group (n = 18) and the conventional wound therapeutic (CWT) group (n = 22). The efficacy evaluations included the time to complete re-epithelialization of the wound and healing speed within 14 days of graft treatment or after 14 days of graft treatment in the two groups. Before the treatment, the graft group had a significantly larger ulcer area than the CWT group [27.22 (15.28, 46.59) versus 10.92 (7.00, 24.93) cm2 , P < .01]. However, the time to complete wound re-epithelialization in the graft group was shorter than in the CWT group [58.22 ± 30.60 versus 86.09 ± 49.54 d, P < .05]. Meanwhile, the healing speed in graft group was markedly faster than in CWT group, whether within 14 days [0.60 (0.40, 0.92) versus 0.16 (0.07, 0.34) cm2 /d, P < .01] or after 14 days of graft treatment [0.57 (0.45, 0.91) versus 0.13 (0.08, 0.27) cm2 /d, P < .01]. However, the total treatment cost in the graft group was lower than in the CWT group [419.59 ± 137.20 versus 663.97 ± 497.02 $, P < .05]. The novel treatment modality of autologous full-thickness skin graft taken from the ulcer wound margin combined with NPWT has hereby proposed for the first time, and is a safe, effective, and reliable method with a good performance-to-cost ratio to promote wound healing and shorten the healing time for DLEUs.

Refractory wounds induced by normal-renal calciphylaxis: An under-recognised calcific arteriolopathy.

BACKGROUND: Normal-renal calciphylaxis (NRC) is a devastating calcific vasculopathy characterised by refractory wounds. It is more likely to be misdiagnosed because of the absence of renal insufficiency. Failure to effectively control may lead to rapid deterioration and ultimately death. However, current knowledge of it is still inadequate. OBJECTIVES: To provide a relatively comprehensive review of NRC. METHODS: Nine electronic medical databases including PubMed, Web of Science, Embase, the Cochrane Library and so on were searched from inception to April 1, 2022. Articles in which calciphylaxis was diagnosed in patients with normal renal function were included. RESULTS: Totally 140 articles were retrieved with 187 patients (median age, 62 years [IQR, 49.63 ~ 75.70 years]; 83.42% female; 84.5% Caucasian). Vitamin K antagonism (43.32%) and diabetes (39.57%) accounted for most of the concomitant factors. Cutaneous presentations were the most common. Pathological confirmation was made in 97.86% of patients with an accuracy of 99.45%. Multidisciplinary therapeutic strategies were usually implemented while the final prognosis was not ideal, with a 6-month mortality rate of 21.10% and a 1-year mortality rate of 27.52%. CONCLUSION: NRC is an under-recognised disease caused by a variety of factors; meanwhile, multidisciplinary efforts are required to inform diagnostic and therapeutic decisions.

The efficacy and safety of platelet-rich plasma in the tendon-exposed wounds: a preliminary study.

OBJECTIVE: Currently, among wounds with large skin tissue defects caused by various reasons, the treatment of refractory wounds is still a major clinical problem. This study is aimed to preliminarily assess the therapeutic potentials of platelet-rich plasma (PRP) in refractory wounds with exposed tendons, as well as corresponding efficacy and safety. METHODS: A total of 12 patients (5 males and 7 females) with refractory wounds and exposed tendons who were admitted to our hospital from June 2018 to December 2020 were included in this study. After the preparation of PRP, the included patients underwent the PRP injection after the debridement of wounds, and the efficacy and prognosis were assessed by the same group of senior surgeons. RESULTS: The average age of included patients was 42.7 ± 12.9 years, and the causes of injury included traffic accidents (3 cases), contusion (2 cases), burns (2 cases), diabetes complications (4 cases), and melanoma complications (1 cases). The average healing time was 23.0 ± 5.0 days, and the mean size of the wound was 3.1 × 5.1 cm2. During the whole treatment process, Vancouver Scar Scale (VSS) decreased from 7.4 ± 1.6 before PRP treatment to 3.6 ± 0.9 after treatment (P < 0.001), Manchester Scar Scale (MSS) decreased from 12.3 ± 4.5 before PRP treatment to 5.4 ± 1.2 after treatment (P < 0.001), and no redness and swelling were observed around wounds, the size and degree of wounds gradually reduced, the coverage rate of granulation tissue was acceptable, overall quality of scar was relatively good, skin sensitivity around wounds was normal, there was no local wounds secretion, and postoperative patient's satisfaction was relatively good during follow-up. CONCLUSIONS: Our study has preliminarily indicated that PRP can promote the wounds healing, reduce the inflammation around wounds, and improve the granulation tissue and angiogenesis, thereby effectively polishing up the safety and efficacy.

Extracellular vesicle: A magic lamp to treat skin aging, refractory wound, and pigmented dermatosis?

Exposure of the skin to an external stimulus may lead to a series of irreversible dysfunctions, such as skin aging, refractory wounds, and pigmented dermatosis. Nowadays, many cutaneous treatments have failed to strike a balance between cosmetic needs and medical recovery. Extracellular vesicles (EVs) are one of the most promising therapeutic tools. EVs are cell-derived nanoparticles that can carry a variety of cargoes, such as nucleic acids, lipids, and proteins. They also have the ability to communicate with neighboring or distant cells. A growing body of evidence suggests that EVs play a significant role in skin repair. We summarize the current findings of EV therapy in skin aging, refractory wound, and pigmented dermatosis and also describe the novel engineering strategies for optimizing EV function and therapeutic outcomes.

Effect of Alcohol Extract of Spore Powder of Lasiosphaera Calvatia on Wound Healing of Full-thickness Skin Defect in Mice / 中国实验方剂学杂志

ObjectiveTo compare the effect of different solvent extracts of spore powder and fruiting body of Lasiosphaera Calvatia on fibroblasts and wound healing of full-thickness skin defect， in order to screen the optimal medication part of Lasiosphaera Calvatia. MethodThe effect of water extract and alcohol extract of spore powder and fruiting body on cell proliferation and cell migration of mouse skin fibroblasts （MSF） were examined in vitro. Cell proliferation and activity test （CCK-8） method was used for cell proliferation， scratch assay was used for cell migration， flow cytometry was conducted to explore cell cycle， enzyme-linked immunosorbent assay （ELISA） was used to determine the production of collagen Ⅰ and Ⅲ. At the same time， a full-thickness skin defect wound model was established to investigate the therapeutic effect of different solvent extracts of spore powder. Ultraviolet-visible spectrophotometry was used to measure the contents of index components in different solvent extracts. ResultThe water extract of spore powder and fruiting body had certain cytotoxicity， while the alcohol extract could promote proliferation， migration and production of collagen Ⅰ and Ⅲ of MSF， and the effect of spore powder was significantly higher than that of fruiting body. When the concentration was 10 mg·L-1， the cell proliferation rate of alcohol extract of spore powder was as high as （159.22±15.95）%， and could promote MSF from the G0/G1 phase to S phase and G2/M phase with an increased proliferation index. The alcohol extract also promoted the migration of fibroblasts， secreted collagen Ⅰ and Ⅲ. On in vivo model， the alcohol extract of spore powder significantly accelerated wound healing on mice， effectively promoted the complete epithelialization of wound tissue， and generated new collagen fiber. The results of determination showed that the contents of polyphenols and flavonoids in the alcohol extract were higher than the alcohol extract of fruiting body. ConclusionThe alcohol extract of spore powder in Lasiosphaera Calvatia has active components in the treatment of wounds with good development prospect， and the medicinal components may be polyphenols and flavonoids.

Artificial Dermis and Autologous Platelet-Rich Plasma for Treatment of Refractory Wounds: A Clinical Study.

Refractory wounds present a complex and serious clinical dilemma in plastic and reconstructive surgery. However, there are currently no standard guidelines for the treatment of refractory wounds. Artificial dermis (AD) has achieved some satisfactory results, but also has some limitations. Autologous platelet-rich plasma (PRP), as a cell-therapy material, was a valuable and safe treatment dressing for chronic non-healing wounds. This study aimed to evaluate the efficacies of artificial dermis (AD) with and without autologous platelet-rich plasma (PRP) in patients with refractory wounds. Sixteen patients with refractory wounds were randomly allocated to autologous PRP therapy combined with artificial dermis (PRP + AD [N = 8]) or an artificial dermis program only (AD [N = 8]). We compared the efficacies of the two methods in terms of times to wound healing, infection control, and AD vascularization, as well as hospitalization days and eventual clinical outcomes.13 patients achieved complete healing, including seven (87.5%) in the PRP + AD group and six (75.0%) in the AD group (P > .05). The times to wound healing, infection control, and AD vascularization, and hospitalization time after transfer were significantly shorter in the PRP + AD group compared with the AD group (P < .05). In conclusion, the combination of AD and PRP promoted refractory wound healing and shortened waiting times compared with simple dermal grafts.

[Clinical effects of autologous platelet rich plasma gel combined with vacuum sealing drainage techno-logy in repairing refractory wounds].

Objective: To investigate the clinical effects of autologous platelet rich plasma (PRP) gel in combination with vacuum sealing drainage (VSD) technology in repairing refractory wounds. Methods: From March 2011 to January 2015, 44 patients with refractory wounds meeting the inclusion criteria were recruited into VSD alone group, who were admitted to the Department of Burns and Plastic Surgery of the Yidu Central Hospital of Weifang and received intermittent VSD treatment. From February 2015 to September 2019, 43 patients with refractory wounds meeting the inclusion criteria were recruited into PRP+ VSD group, who were admitted to the same unit as above-mentioned and received PRP combined with intermittent VSD treatment. The retrospective cohort study was conducted. There were 24 males and 20 females with age of (37.5±2.2) years in VSD alone group, and there were 25 males and 18 females with age of (37.0±2.5) years in PRP+ VSD group. The wound exudate of patients in the two groups before and 7 and 14 d after the first treatment were collected for bacterial culture, and the positive rate of bacterial culture was calculated. The wound healing of patients in the two groups was observed on 7, 14, and 21 d after the first treatment, and the wound healing rate was calculated. The complete wound healing time of patients in the two groups was recorded. The degree of wound pain of patients in the two groups was evaluated by the Visual Analog Scale (VAS) before and 14 d after the first treatment. The scar hyperplasia of patients in the two groups was evaluated by the Vancouver Scar Scale (VSS) in 1 and 2 months after the wound healed completely. The occurrence of adverse reactions of patients in the two groups during the whole period of treatment was observed and the incidence of adverse reactions was calculated. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, paired t test, and Bonferroni correction. Results: The positive rates of bacterial culture in wound exudate of patients in PRP+ VSD on 7 and 14 d after the first treatment were 37.2% (16/43) and 11.6% (5/43), which were significantly lower than 56.8% (25/44) and 29.5% (13/44) in VSD alone group, χ(2)=4.212, 4.255, P<0.05. The wound healing rates of patients in PRP+ VSD group on 7 and 14, and 21 d after the first treatment were respectively (58±14)%, (70±13)%, (89±12)%, which were significantly higher than (41±11)%, (60±11)%, (74±12)% in VSD alone group, t=6.323, 3.820, 5.751, P<0.01. The complete wound healing time of patients in PRP+ VSD group was (30±6) d, which was significantly shorter than (61±8) d in VSD alone group, t=20.890, P<0.05. The VAS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group on 14 d after the first treatment (t=13.904, P<0.01). The VSS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group in 1 and 2 months after the wound healed completely (t=3.307, 3.637, P<0.01). The incidence of adverse reactions of patients in PRP+ VSD group during the whole period of treatment was 7.0% (3/43), which was significantly lower than 22.7% (10/44) in VSD alone group, χ(2)=4.245, P<0.05. Conclusions: Autologous PRP gel combined with VSD technology in repairing refractory wounds not only has good bacteriostatic effect, but also can increase wound healing rate, shorten wound healing time, alleviate wound pain, reduce scar hyperplasia, with less adverse reaction, which is worthy of promotion.

Effect of platelet-rich plasma on pressure ulcers after spinal cord injury / 中国组织工程研究

BACKGROUND: Studies have reported that platelet-rich plasma (PRP) can promote accelerated healing of pressure injury. OBJECTIVE: To explore the effect of PRP on pressure injury of patients with spinal cord injury. METHODS: From July 2017 to December 2019, 40 patients with spinal cord injury complicated by stage 3 and stage 4 pressure ulcers were randomly divided into a PRP group (n=20) and a control group (n=20) using a random number table. Patients in the control group were given routine wound care and standardized rehabilitation treatment, whereas those in the PRP group received PRP treatment based on routine wound care and standardized rehabilitation treatment once a week. The surface area, wound type and exudate volume were assessed by pressure ulcer scale for healing (PUSH) before treatment and 2, 4, 6, 8 weeks after treatment. The total PUSH score, score of each item in the PUSH scale, and clinical efficacy were compared between the two groups. An ethical approval was obtained from the Biomedical Ethics Committee of West China Hospital of Sichuan University, with an approval No. 2019(622). RESULTS AND CONCLUSION: The total PUSH score and scores in terms of wound area, type, and exudate volume were significantly reduced after treatment in the PRP group (P < 0.01), while those scores in the control group were also significantly reduced at 6 and 8 weeks after treatment (P < 0.01). Compared with the control group, the total PUSH score and scores on exudate volume were significantly lower in the PRP group at 4, 6, and 8 weeks after treatment, and the scores on wound type were significantly lower in the PRP group at 6 and 8 weeks after treatment. The healing rate in the PRP group was 100% after treatment, which was significantly higher than that in the control group (35%; P < 0.001). These findings indicate that PRP treatment contributes to the recovery of pressure injury in patients with spinal cord injury.

Platelet-rich plasma combined with negative pressure for chronic refractory wounds: A meta-analysis / 中国组织工程研究

BACKGROUND: Platelet-rich plasma and negative pressure drainage therapy have been widely used and achieved good clinical outcomes in the treatment of various chronic wounds. However, there is no randomized controlled trial regarding their combined effect on chronic refractory wounds. OBJECTIVE: To systematically evaluate the efficacy of platelet-rich plasma with negative pressure therapy on chronic refractory wounds. METHODS: Databases of CNKI, VIP, WanFang, SinoMed, Web of Science, PubMed, and EMbase were searched for the randomized controlled trials regarding the efficacy of platelet-rich plasma combined with negative pressure therapy on chronic refractory wounds. Included studies were evaluated using the Cochrane system evaluation method. Meta-analysis was performed using RevMan 5.3 software. The primary outcomes included wound healing rate, time for wound healing, length of hospital stay, pain score and positive rate of bacteria. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials were included, including 743 patients with chronic wounds. The observation group was treated with platelet-rich plasma combined with negative pressure drainage. The control group was treated with conventional dressing or simple negative pressure drainage. The Meta-analysis results showed that compared with the control group, there was significantly increased wound healing rate [relative risk (RR)=2.19, 95% confidence interval (CI) (1.82, 2.62), P < 0.000 01], significantly shortened time for wound healing [mean standard difference=-0.81, 95%CI (-1.00,-0.62), P < 0.000 01], significantly shortened length of hospital stay [mean difference=-7.11, 95%CI (-8.12,-6.11), P < 0.000 01], and significantly lowered positive rate of bacteria [RR=0.35, 95%CI (0.22, 0.54), P < 0.000 01] in the observation group. There was no significant difference between the two groups in the pain score [SMD=-5.97, 95%CI (-14.33, 2.40), P=0.16]. To conclude, platelet-rich plasma combined with negative pressure drainage can promote the healing of chronic refractory wounds and reduce the incidence of infection.

[One patient with chronic refractory wound caused by bamboo sticks in lower leg].

One patient with chronic refractory wound in right lower leg was admitted to our department in June 2017, which experienced repeated ulceration for 4 years. On 4 days post admission, two bamboo sticks were taken out from the deep muscle of the right lower leg. The wound was repaired by perforator flap of posterior tibial artery in the right lower leg. The donor site was covered with split-thickness skin in the upper leg of the same side. On 7 days post operation, the flap and skin graft survived. During follow-up of 12 months, the flap had good appearance. This case suggests that the first thing for the treatment of chronic refractory wound is to find out the cause of wound.