Platelet-rich fibrin matrix shows promise for trophic ulcers

Platelet-rich fibrin matrix (PRFM) compares favourably with platelet-rich plasma (PRP) in the treatment of chronic trophic ulcer associated with leprosy, as shown in the results of an observer-blind, noninferiority randomized controlled trial.

In a cohort of patients with chronic or nonhealing ulcers (>6 weeks duration) with sizes between 1-by-1 and 5-by-5 cm, both PRFM and PRP led to a significant reduction in the ulcer surface area (p<0.001 for both), with improvements evident as early as the first follow-up (p<0.05), reported Dr Monica Das, a dermatology expert from India, who spoke at WCD 2023. [Mukherjee A, et al, WCD 2023]

A total of 23 percent and 12 percent of patients in the PRFM and PRP group, respectively, achieved complete improvement of their ulcers (p=0.465). In parallel, quality of life (as evaluated using the Dermatology Life Quality Index [DLQI]) increased significantly in both groups (p<0.001), Das added.

In terms of safety, there were no adverse events documented during the procedure in either group. None of the patients in either group had treatment-emergent side effects, and their haematological and biochemical parameters were within normal limits.

The safety profile of PRFM in the present study is consistent with the previous studies, Das noted.

Speeding up healing

“Autologous PRFM is rich in growth factors, and fibrin matrix acts as an excellent drug delivery system. It is a promising treatment option for chronic or nonhealing ulcers,” which are difficult to manage for the physician and frustrating for the patient, according to Das.

PRFM acts by accelerating wound healing through the release of growth factors such as platelet-derived growth factors, transforming growth factors, vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF), interleukin-1, and fibrinogen, among others.

Compared with conventional PRP, PRFM has about three times greater mean growth factor concentration in the platelet concentrates. Additionally, PRFM is simpler to prepare and does not require biochemical blood handling.

“Dressing with PRFM is a simple, cheap, and safe day care procedure using autologous blood, [and can be administered] without anticoagulants,” Das stated, adding that the procedure can be safely performed even by less experienced healthcare providers.

“[Owing to] operational ease (ie, less blood, less time), PRFM is a better alternative to PRP and [should] be included in [the] guideline,” she continued.

However, Das acknowledged that while faster healing can be achieved with autologous PRFM, this treatment does not directly address the cause of ulcer and, hence, recurrences cannot be prevented. In the present study, the recurrence rate was about 20–30 percent.

“So, practicing proper foot care is of utmost importance,” she said.

The study included 72 patients with 83 ulcers. All of them underwent routine blood tests, clinical examination, and local assessment (number, depth, area, volume, margin, presence/absence of granulation tissue). Wound aetiologies included Hansen’s, arterial, diabetic, venous, or traumatic wound.

Given the uncontrolled nature of the study and its lack of comparison, randomized controlled trials are needed to validate the present data, according to Das.