Regenerative Therapy In Chronic Wounds: Platelet-Derived Growth Factors, Scaffold And Stem Cell (#345)
Introduction: There is no ideal procedure for the treatment of recalcitrant ulcers which are not responsive to the most common treatments. Considering the pathophysiology of chronic non healing wounds, the more widely recognized causative factors are 1) significantly decreased local concentration, stability and bioavailability of growth factors; 2) phenotypically altered and/or senescent mesenchymal cells which fill the dermis of the skin; 3) a significantly higher local activity of matrix metalloproteinases which degrades extracellular matrix, impairs tissue repair, and suppresses cell proliferation and angiogenesis. Accordingly, the success and efficacy of chronic wound healing depends on the correction of the local growth factors concentration and wound matrix; and the reconditioning of phenotypically altered resident cells. Methods: Twenty one patients were treated with the combination of allogenic platelets, fibrin glue and collagen matrix (PFC) topically each two days on the wound. For another eight patients, just for one time, the autologous marrow-derived cells were injected/applied topically into the wound along with autologous platelets, fibrin glue and bone marrow-impregnated collagen matrix (stem-PFC). Results: For 21 with PFC treatment, the wound was completely closed in 17 patients and significantly reduced in the 2 patients and no sign of improvement in 2 patients. Mean 100% healing time for all patients was 18.1 weeks. For 8 patients with stem-PFC treatment, the wound was completely closed in three patients after four weeks, in one patient after 12 weeks and significantly reduced in the remaining four patients. There was no evidence of local or systemic complications. Conclusions: Our study suggests that the combination of the components mentioned can be used safely in order to synergize the effect of chronic wound healing. This study suggests that based on these positive preliminary findings, a larger adequately powered trial is needed to investigate and confirm the efficacy of each procedure in long term outcome.