The efficacy of intralesional injection of autologous platelet rich plasma versus normal saline dressing in chronic non-healing ulcers

Narender Singh, Shaitan S. Rathore, Garima Choudhary, Lakhan K. Purohit


Background: Platelet-rich plasma (PRP) can potentially enhance healing of chronic non-healing ulcer by increasing the delivery of various growth factors from the α-granules contained in platelets. Aim of this prospective randomized study was to evaluate the efficacy of autologous PRP versus normal saline (NS) at chronic non healing ulcer in relation to wound healing on the basis of ulcer size reduction, duration of healing, complete or partial healing and side effects

Methods: Fifty four patients with chronic non-healing ulcer were randomly divided into two equal groups: PRP group (treated with PRP) and NS group. Observations were made regarding pain, slough, discharge, granulation, reduction in ulcer size and volume on every 7th day till 4 weeks.

Results: Reduction in area and volume of ulcers at the end of treatment was 12.27±4.10 cm2 and 6.88±5.26 cm3 in PRP group and 9.25±1.89 cm2 and 4.25 ±1.05 cm3 in NS group. In PRP group 59.25% had no discharge, 74.08% had no slough, 62.97% had no pain while in NS group no patient was without discharge, 14.81% patient had no slough, 74.07% had minimal pain on 28th day. In PRP group 22.22% ulcers were completely healed while in NS groups all ulcers were partially healed.

Conclusions: PRP is more effective than NS on chronic non-healing ulcers as it causes more rapid healing, rapid relief from pain and early decrease in discharge and slough in all age groups and sex; irrespective of type, size, site, duration and etiology of ulcer.


Chronic non-healing ulcer, Growth factor, Normal saline, Platelet-rich plasma

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Bhanot S, Alex JC. Current applications of platelet gels in facial plastic surgery. Facial Plast Surg. 2002;18:27-33.

Buckwalter JA, Einhorn TA, Bolander ME, Cruess RL. Healing of musculoskeletal tissues. In: Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, eds. Fractures in Adults. 4th edn. Philadelphia: Lippincott Raven; 1996:261-304.

Anderson JM. The cellular cascades of wound healing. In: Davies JE, ed. Bone Engineering. Toronto: Em Squared Inc.; 2000:81-93.

Froum SJ, Wallace SS, Tarnow DP, Cho SC. Effect of platelet-rich plasma on bone growth and osseointegration in human maxillary sinus grafts: three bilateral case reports. Int J Periodont Restorat Dent. 2002;22:45-53.

Petrungaro PS. Using platelet-rich plasma to accelerate soft tissue maturation in esthetic periodontal surgery. Compend Contin Educ Dent. 2001;22(9):729-36.

Guyton AC. Physiology of the human body. Philadelphia: Saunders College Publishing; 1979.

Harrison P, Cramer EM. Platelet alpha-granules. Blood Rev. 1993;7:52-62.

Welsh WJ. Autologous platelet gel-clinical function and usage in plastic surgery. Cosmet Derm. 2000;13:13-8.

Weibrich G, Kleis WK, Hafner G, et al. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count. J Craniomaxillofac Surg. 2002;30:97-102.

Tischler M. Platelet rich plasma. The use of autologous growth factors to enhance bone and soft tissue grafts. N Y State Dent J. 2002;68:22-4.

Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thrombos haemostas. 2004;91(01):4-15.

Robiony M, Polini F, Costa F, Politi M. Osteogenesis distraction and platelet-rich plasma for bone restoration of the severely atrophic mandible: preliminary results. J Oral Maxillofac Surg. 2002;60(6):630-5.

Steed DL. Clinical evaluation of recombinant human plateletderived growth factor for the treatment of lower extremity diabetic ulcers. Diabetic Ulcer Study Group. J Vasc Surg. 1995;21(1):71-81.

Gandhi AV, Van Gelderen J, Berberian WS, O’Connor JP, Parsons JR, Lin SS. Platelet releasate enhances healing in patients with a non-union. In: Transactions of the 49th Annual Meeting of the Orthopaedic Research Society, New Orleans, LA. 2003;45.

Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10:225-8.

Ferrari M, Zia S, Valbonesi M, Henriquet F, Venere G, Spagnolo S, et al. A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery. Int J Artific Organs. 1987;10(1):47-50.

Li ZJ, Choi HI, Choi DK, Sohn KC, Im M, Seo YJ, et al. Autologous platelet‐rich plasma: a potential therapeutic tool for promoting hair growth. Dermatolog Surg. 2012;38(7pt1):1040-6.

Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg. 2004;62(4):489-96.

Borzini P, Mazzucco L. Platelet gels and releasates. Curr Opin Hematol. 2005;12(6):473-9.

San Sebastian KM, Lobato I, Hernández I, Burgos-Alonso N, Gomez-Fernandez MC, López JL, et al. Efficacy and safety of autologous platelet rich plasma for the treatment of vascular ulcers in primary care: Phase III study. BMC Fam Pract. 2014;15(1):211.

Greer N, Foman NA, MacDonald R, Dorrian J, Fitzgerald P, Rutks I, et al. Advanced wound care therapies for nonhealing diabetic, venous, and arterial ulcers: a systematic review. Ann Intern Med. 2013;159(8):532-42.

Yaun T, Zhang CQ, Tang MJ, Guo SC, Zeng BF. Autologous platelet rich plasma enhances wound healing in chronic wounds. Wounds. 2009;2I:280-5.

Kakudo N, Kushida S, Ogura N, Hara T, Suzuki K. The use of autologous platelet rich plasma in the treatment of intractable skin ulcer. Open J Reg Med. 2012;1:29-32.

Martin P. Wound healing- aiming for perfect skin regeneration. Science. 1997;276:75-81.

Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III lecucocyte activation: a new feature for platelet concentrates. Oral Surg Oral Med Oral Patho Oral Radiol Endod. 2006;101:e5I-5.

Lacci MK, Dardik A. Platelet-rich plasma: support for its use in wound healing. Yale J Biol Med. 2010;83(1):1-9.

Martin P. Wound healing- aiming for perfect skin regeneration Science. 1997;276:75–81.

Kakudo N, Kushida S, Ogura N, Hara T, Suzuki K. The use of autologous platelet rich plasma in the treatment of intractable skin ulcer. Open J Reg Med. 2012;1:29-32.

Driver VR, Hanft J, Fylling CP, Beriou JM, Autologel Diabetic Foot Ulcer Study Group. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostom Wound Manage. 2006;52(6):68-74.

Suthar M, Gupta S, Bukhari S, Ponemone V. Treatment of chronic non-healing ulcers using autologous platelet rich plasma: a case series. J Biomed Sci. 2017;24(1):16.