Platelet-rich Fibrin With Adipose-derived Stem Cells for the Treatment of Chronic Cutaneous Wounds: A Randomized Clinical Trial

INTRODUCTION: Chronic wounds represent a relevant healthcare problem with enormous social and economic burden. Regenerative surgery offers innovative options for the treatment of chronic ulcers with promising results and reduced rate of complications.1–4 The aim of this randomized clinical trial was to compare the application of platelet-rich fibrin (PRF) combined with autologous adipose-derived stem cells (ASCs) versus the application of PRF alone for the treatment of chronic cutaneous ulcers. MATERIALS AND METHODS: To date, 33 patients with chronic skin ulcers have been randomized in 2 different groups: PRF alone (control group: 19 patients) and PRF + ASCs (experimental group: 14 patients). Patients with neoplastic or clinically infected wounds have been excluded from the study. The production and application of PRF or PRF + ASCs have been performed with Vivostat (Alleroed, Denmark). In our study, we used PRF and PRF + ASCs by local application and infiltration of wound margins. Patients were evaluated up to 12 weeks after the procedure with regular office visits. At week 4 and 12, we also preformed laser Doppler flowmetry and transcutaneous oximetry.5 RESULTS: Patients reported significant pain reduction in both groups. Results of laser Doppler flowmetry and transcutaneous oximetry provided promising results in terms of increased wound bed perfusion and oxygenation. Control group showed wound area reduction of 16% at 4 weeks and 49% at 12 weeks postoperatively, whereas in the experimental group, the area reduction was 49% and 81% at 4 and 12 weeks, respectively. CONCLUSIONS: Both treatments may represent a feasible option for the treatment of chronic wounds. Our preliminary data suggest that the application of PRF + ASCs enhance the healing process more effectively than the PRF alone. REFERENCES: 1. Caruana G, Bertozzi N, Boschi E, et al. Role of adipose-derived stem cells in chronic cutaneous wound healing. Ann Ital Chir.2014;86:1–4. 2. Bertozzi N, Simonacci F, Grieco MP, et al. The biological and clinical basis for the use of adipose-derived stem cells in the field of wound-healing. Ann Med Surg. 2017;20:41–48. 3. Raposio E, Bertozzi N. Isolation of ready-to-use adipose-derived stem cell (ASC) pellet for clinical applications and a comparative overview of alternate methods for ASC isolation. Curr Protoc Stem Cell Biol. 2017;41:1F.17.1–1F.17.12. doi:10.1002/cpsc.29. 4. Raposio E, Bertozzi N. How to isolate ready-to-use adipose-derived stem cells pellet for clinical application. Eur Rev Med Pharmacol Sci. 2017;21:4252–4260. 5. Raposio E, Bertozzi N, Moretti R, et al. Laser Doppler flowmetry and transcutaneous oximetry in chronic skin ulcers: a comparative evaluation. Wounds Epub. 2017;29:190–195.