THE SECOND-GENERATION PLATELET CONCENTRATES IN THE TREATMENT OF CHRONIC OSTEOMYELITIS: ONE MODERN REGENERATIVE SURGERY

Alessandro Crisci; D’Adamo Raffaele; Michela Crisci

doi:10.29121/granthaalayah.v8.i10.2020.1842

Authors

Alessandro Crisci School of Medicine, University of Salerno Italy, 84084 Fisciano, SA, Italy; Unit of Dermosurgery Cutaneous Transplantations and Hard-to-HealWound, “Villa Fiorita” Private Hospital, 81031 Aversa, CE, Italy; Institute for the Studies and Care of Diabetics, Abetaia, 81020 Casagiove, CE, Italy https://orcid.org/0000-0002-4478-5714
D’Adamo Raffaele Unit of Dermosurgery Cutaneous Transplantations and Hard-to-HealWound, “Villa Fiorita” Private Hospital, 81031 Aversa, CE, Italy
Michela Crisci Faculty of Medicine and Surgery, Vasile GoldisWestern University of Arad, 310025 Arad, Romania

DOI:

https://doi.org/10.29121/granthaalayah.v8.i10.2020.1842

Keywords:

Osteomyelitis, Buffy Coat, Level Of Growth Factors, Platelet-Rich Fibrin, Thrombocyte Concentrate

Abstract [English]

Background: Hypothesis is that the use of fibrin rich in leukocytes and platelets advanced (A-PRF) in ulcer osteomyelitis on diabetic foot, allows recovery from this serious disease. In this study, the goal was to standardize the use of PRF in patients with osteomyelitis, to use this second-generation platelet concentrate, as a facilitator of healing.

Methods: Authors produced and used peripheral blood A-PRF (1300 g × 8 min) membranes in 7 patients (all diabetic) with osteomyelitis and skin lesions for at least 6 months. Membranes, together with the supernatant liquid derived from compression, were inserted into the skin lesion down to the bone after surgical debridement. Evolution of the lesions over time was analyzed.

Results: All seven patients had a positive Probe-to-Bone test, MRI detected cortico-periosteal thickening and/or foci of cortico-cancellous osteolysis adjacent to the ulcer. Gram-positive bacteria were found in our patients in 52% of cases. Cocci Gram +, such as S. Aureus (15.6%), S. -haemolytic (12.1%), S. Viridans (7.1%), and Bacilli Gram- such as Pseudomonas (10.6%), Proteus (7.8%), Enterobacter (5.7%) are present. Candida Albicans is present in 2.8%. Blood count showed no major changes.

To date, skin lesions have healed in 6 of the seven patients treated (one patient for more than five years) with no signs of infection or recurrence.

Conclusions: Results obtained on our patients suggest that PRF membranes may be a therapeutic option in this difficult to treat pathology.

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References

Choukroun, J., Adda, F., Schoeffler, C., Vergelle, A., Une opportunité en paro-implantologie: le PRF. Implantodontie, 2010, 62, 42-55.

Toffler, M., Toscano, N., Holtzclaw, D., Del Corso, M., Dohan Ehrenfest, D., Introducing, Choukroun mins platelet rich fibrin (PRF) to reconstructive surgery milieu. J.I.A.C.D., 2009, 6, 21-32.

Lew, D.P., Waldvogel, F.A., Osteomyelitis. Lancet, 2004, 364, 369-379. DOI: https://doi.org/10.1016/S0140-6736(04)16727-5

Calhoun, J.H., Manring, M.M., Shirtliff, M., Osteomyelitis of the Long Bones. Seminars in Plastic Surgery, 2009, 23, 59-72. http://doi.org/10.1055 / s-0029-1214158

Gogia, J.S., Meehan, J.P., Di Cesare, P.E., Jamali, A.A., Local antibiotic therapy in ostemyelitis. Seminars in Plastic Surgery, 2009, 23, 100-107. http://doi.org/10.1055 / s-0029-1214162 DOI: https://doi.org/10.1055/s-0029-1214162

Crisci, A., Marotta, G., Licito, A., Serra, E., Benincasa, G., Crisci, M., Use of leukocyte platelet (L-PRF) rich fibrin in diabetic foot ulcer with osteomyelitis (three clinical cases report), Diseases, 2018, 6, 30. http:// doi.org/10.3390/diseases6020030. DOI: https://doi.org/10.3390/diseases6020030

Miron, R.J., Fujioka-Kobayashi, M., Hernandez, M., Kandalam, U., Zhang, Y., Ghanaati, S., Choukroun, J., Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry? Clinical oral investigations, 2017, 21, 2619-2627. http://doi.org/10.1007 / s00784-017-2063-9 DOI: https://doi.org/10.1007/s00784-017-2063-9

Schär, M.O., Diaz-Romero, J., Kohl, S., Zumstein, M.A., Nesic, D., Platelet-rich Concentrates Differentially Release Growth Factors and Induce Cell Migration In Vitro. Clin. Orthop. Relat. Res., 2015, 473, 1635–1643. DOI: https://doi.org/10.1007/s11999-015-4192-2

https:// doi.org/10.1007/s11999-015-4192-2

Miron, R.J., Chai, J., Fujioka-Kobayashi, M., Sculean, A., Zhang, Y., Evaluation of 24 protocols for the production of platelet-rich fibrin, in press, http:// doi.org/ 10.21203/rs.2.20730/v1

Crisci, A., Lombardi, D., Serra, E., Lombardi, G., Cardillo, F., Crisci, M., Standardized protocol proposed for clinical use of L-PRF and the use of L-PRF Wound Box®. J. Unexplored Med. Data, 2017, 2, 77-87. http:// doi.org/10.20517/2572-8180.2017.17. DOI: https://doi.org/10.20517/2572-8180.2017.17

Crisci, A., Lombardi, D., Serra, E., Lombardi, G., Cardillo, F., Crisci, M., L-PRF: standardized protocol proposed for the use of fibrin rich in leukocite platelet and the use of L-PRF Wound Box. Selection of an animal model. Update in Plastic Surgery, 2017, 3, 141-149.

Crisci, A., The L-PRF Membrane (Fibrin Rich in Platelets and Leukocytes) and Its Derivatives (A-PRF, I-PRF) Are Useful as a Source of Stem Cells in Regenerative Wound Therapy: Experimental Work on the Horse. Regen. Med. Ther., 2019, 3, 37-45. http:// doi.org/10.36959 / 654/392 DOI: https://doi.org/10.36959/654/392

D’asta, F., Halstead, F., Harrison, P., Zecchi Orlandini, S., Moiemen, N., Lord, J., The contribution of leucocytes to the antimicrobial activity of platelet-rich plasma preparations: A systematic review, Platelets, 2018, 29, 9-20. http:// doi.org/10.1080/09537104.2017.1317731 DOI: https://doi.org/10.1080/09537104.2017.1317731

Kawase, T., Mubarak, S., Mourão, C.F., The Platelet Concentrates Therapy: From the Biased Past to the Anticipated Future, Bioengineering, 2020, 7, 82. https://doi.org/10.3390/bioengineering7030082 DOI: https://doi.org/10.3390/bioengineering7030082

Apostólico, J.S., Lunardelli, V.A., Coirada, F.C., Boscardin, S.B., Rosa, D.S., Adjuvants: Classification, Modus Operandi, and Licensing., J. Immunol. Res., 2016, 1459394. https://doi.org/10.1155/2016/1459394 DOI: https://doi.org/10.1155/2016/1459394

Crisci, A., La gestione dell’osteomielite nel piede diabetico. In: Crisci A. Il piede diabetico: nuove prospettive di prevenzione e cure, Ed. Aracne, Roma; 2014, 109-113.

Madurantakam, P., Yoganarasimha, S., Hasan, F.K., Characterization of leukocyte-platelet rich Fibrin, a novel biomaterial., J. Vis. Exp., 2015, 29, 53221. https:// doi.org/10.3791/53221 DOI: https://doi.org/10.3791/53221

Cieslik-Bielecka, A., Dohan Ehrenfest, D.M., Lubkowska, A., Bielecki, T., Microbicidal properties of leukocyte-and plate- let-rich plasma/fibrin (L-PRP/L-PRF): new perspectives., J.B.R.H.A., 2012, 2, 43-52.

Crisci, A., Benincasa, G., Crisci, M., Crisci, F., Leukocyte Platelet Rich Fibrin (L-PRF), a new bio membrane useful in tissue repair: basic science and literature review., Bio. Interface Res. Appl. Chem., 2018, 5, 3635-3643.

Crisci, A., Crisci, F., Crisci, M., Second-Generation Platelet Concentrates (L-PRF, A-PRF, i-PRF, i-PRF M, i-PRF+) in Cutaneous Wound Surgery of the Foot., Adv. Res. Foot Ankle, 2019, 2, 111. DOI: https://doi.org/10.29011/2688-6413.100011

https:// doi.org/10.29011/ARFA-111.1000011

O'Connell, S.M., Hessler, K., Darik, H., Cascade Autologus System pletelet-rich fibrin in the treatment of chronic leg ulcers. Advanced in wound care, 2012, 1, 52-55. https:// doi.org/10.1089/wound.2011.0290 DOI: https://doi.org/10.1089/wound.2011.0290