Title : Comparison of clinical efficacy of platelet rich plasma combined with double-layer artificial dermis in the treatment of bone or tendon exposed wounds
Abstract:
INTRODUCTION The exposed wound of bone and tendon caused by trauma has always been the focus and difficulty in clinical work. The traditional treatment scheme is skin flap transplantation to repair the wound after debridement. However, this kind of technique not only solves the problem of the affected area, but also brings some damage to the donor area, and once the debridement is not complete, serious soft tissue crushing and other reasons will lead to poor treatment effect, which may cause secondary injury to the patients. In recent years, double-layer artificial dermis and platelet-rich plasma have been used to treat wounds, especially the former has achieved certain results in bone or tendon exposed wounds. The purpose of this study was to compare the clinical efficacy of PRP combined with double-layer artificial dermis and simple double-layer artificial dermis in the treatment of bone or tendon exposed wounds.
METHODS From June 2021 to August 2023, 30 patients with bone or tendon exposure were randomly divided into control group (n=15) and observation group (n=15). After debridement, the observation group was evenly smeared with PRP and then covered with double-layer artificial dermis, while the control group was only covered with double-layer artificial dermis. The granulation tissue coverage at 2 weeks after operation and vancouver scar score (VSS) at 3 months after operation were compared between the two groups.
RESULTS AND DISCUSSION All patients were followed up for 3 months. The wounds of 30 patients healed well and the bone or tendon exposure of all patients were covered effectively, but the granulation tissue coverage rate of the observation group was significantly higher than that of the control group in the second week (P < 0.05). After granulation tissue coverage, 8 patients in the control group were treated with conservative treatment, 7 patients were treated with skin grafting, 4 patients in the observation group were treated with conservative treatment, 11 patients were treated with skin grafting, and all patients healed well. the scar score in the observation group was significantly lower than that in the control group (P < 0.05).
PRP combined with double-layer artificial dermis can promote the growth of granulation tissue of bone or tendon exposed wound, shorten the healing time, reduce the degree of scar in a short time, reduce the trauma of patients, and avoid the secondary injury caused by regional necrosis after skin grafting. When the patients' economic conditions permit, it can be used as one of the treatment methods for bone or tendon exposed wounds, which is worthy of clinical application.
Audience Take Away Notes:
- Skin defects with exposed tendons and bones often occur after hand trauma. It is very important to repair skin defects in a timely manner and perform hand function exercises at an early stage. In the past, the main treatment method was flap transfer and repair. However, this treatment method is more damaging to the patient and takes a long time to recover. It also requires the surgeon to have certain treatment experience [2]. Moreover, once complications such as infection or flap necrosis occur, it will have a great impact on the patient's injury and confidence in treatment
- Double-layer artificial dermis is a membrane-like artificial skin developed in 1980. Its main component is collagen and it has a double-layer structure. The upper layer is a silicone membrane, also known as the epidermis, which can block the invasion of bacteria and other microorganisms in the early stage and prevent the evaporation of water. The lower layer is a sponge with collagen properties and has little tissue immune rejection [3-4]. Its structure provides a regenerative mesh framework for wound healing, which can induce the crawling of capillary networks and granulation tissue and complete the dermis reconstruction of the wound. Double-layer artificial dermis has been used for wound repair in some clinical situations, such as burns, chronic ulcers and trauma. It can provide a platform for structural support and cell migration to promote wound healing and regeneration
- Platelet rich plasma (PRP) is a biological therapy widely used in tissue regeneration and wound treatment. Double-layer artificial dermis is a material that can be used for wound repair and regeneration. At present, there are relatively few clinical studies on the treatment of exposed bone or tendon wounds with PRP combined with double-layer artificial dermis, so there is no clear conclusion on the efficacy and effect of this treatment method. However, this study explored the efficacy of PRP combined with double-layer artificial dermis and simple artificial dermis in the treatment of exposed bone or tendon wounds
- This study is a comparison of the early treatment effects of exposed bone or tendon wounds. The results show that PRP combined with double-layer artificial dermis can promote the growth of granulation tissue on exposed bone or tendon wounds, shorten the healing time, reduce the degree of scarring in patients in the short term, reduce the trauma suffered by patients, and avoid secondary damage caused by regional necrosis after skin grafting. If the patient's economic conditions allow, it can be used as one of the treatment methods for exposed bone or tendon wounds, and it is worthy of clinical promotion and application
