Regenerative plastic surgery to cure ulcers and scarsPietro Gentile MD, Phd
Stromal Vascular Fraction Cells, Platelet-Rich Plasma and our adipose tissue can be used for ulcers and scars cure?
An increasing trend emerged in the use of autologous adipose tissue mixed with stromal vascular cells for soft tissue defects treatment in plastic surgery, besides loss of substances and lower extremity ulcers, as a consequence of the growing demand for minimally invasive interventions focused on using autologous cells and tissue. Scientific literature shows that chronic ulcers have got qualitative and temporal alterations of the wound healing process. However, our current knowledge is limited, since most part of the studies had focused on severe wound healing process experimentally induced, where chronic ulcers microenvironment had been modified.
Previous clinical evaluations validated by scientific researches have shown how platelet rich plasma (PRP) and Stromal Vascular Fraction Cells (SVF) obtained from adipose tissue, facilitate the ulcers and scars repair and enhance fat engraftment for soft tissue defects treatment. Evidently, prevention is better than a cure of chronic ulcers and loss of substances.
What are the benefits and limits?
The procedure’s benefit is the reduction of ulcers healing time than classical methods applied. Also in this case we have to figure out which fields of application it could have, considering exclusion criteria. Patients affected by chronic lower extremity ulcers, post-traumatic loss of substances, diabetic foot ulcers, venous and vascular ulcers, lower extremity soft tissue deficit, can undergo the treatment. The exclusion criteria are divided into 2 types: systemic and local.
The systemic criteria include platelet disorders, thrombocytopenia, anti-aggregating therapy, bone marrow aplasia and cancer. The local criteria include cancer loss of substance. Tobacco use and genetic disorders were not considered as exclusion criteria.
Platelet Rich Plasma Preparation.
In all cases, the preparation procedure will be performed with autologous blood transfusion with approval of Transfusional Service of the hospital according to current regulations. PRP will be collected with the presence of Transfusion Medicine Specialist, from a small volume of blood (18 cc) according to the kit (commercially licensed) used and to the clinical case. Blood was taken from a peripheral venous access collected in two sterile tubes from the kit. The tubes will be subjected to centrifuging for 10 min at 1,100 g as to obtain an average of 20 ml of PRP. The final aim is to obtain a platelet pellet to be directly injected in the ulcer’s bedside and in the perilesional area; as an alternative, it can be performed in combination with centrifuged adipose tissue to correct soft tissue deficit and in loss of substances.
What are the results that can be supposed?
Stromal Vascular Fraction Cells, Platelet-Rich Plasma and biomaterials usage, as reported in the scientific literature, is a promising alternative to the commonly used treatments for ulcers cure and loss of substances repair. The aim is to obtain a healing time reduction, a reduction in terms of invasive treatments and patient’s life quality improvement.