Abstract

Objective

To evaluate the clinical, planimetric, and immunological outcomes of autologous platelet-rich plasma (PRP) as an adjunct to comprehensive treatment of hard-to-heal wounds in patients with neuropathic diabetic foot syndrome.
 

Materials and Methods

This comparative controlled clinical study included 120 patients: 60 in the PRP group and 60 in the comparison group. Both groups received glycaemic correction, surgical debridement with staged necrectomy, offloading, antibiotics when indicated, and local wound care. In the PRP group, 2-5 mL of freshly prepared autologous PRP was additionally applied daily to the wound surface and injected subcutaneously along the wound margins after debridement. Wound dynamics were assessed clinically and by microbiological, cytological, immunological, and computer-assisted planimetric methods. IL-2, IL-6, IL-8, and TNF-α were measured before treatment and on days 7, 14, and 21. Quantitative variables were compared using the Mann-Whitney U test, repeated measurements using the Friedman test, with Holm adjustment for serial between - group comparisons. Categorical outcomes were analysed using Fisher’s exact test.
 

Results

Wound cleansing, granulation, and active marginal epithelialisation occurred mainly by days 12-14 in the PRP group and by days 20-22 in the comparison group. In the planimetric subgroup, wound-healing rate was higher with PRP at all reported time points (adjusted p<0.001). At day 21, between-group differences remained significant for IL-2 (p=0.016), IL-8 (p = 0.004), and TNF-α (p<0.01), but not for IL-6. Major amputations occurred in 4/60 (6.7%) patients in the PRP group and 15/60 (25.0%) in the comparison group (OR=0.22; 95% CI 0.05-0.74; p=0.011). Mortality was 4/60 (6.7%) and 12/60 (20.0%), respectively (OR=0.29; 95% CI 0.06-1.03; p=0.058).
 

Conclusion

Adjunctive autologous PRP was associated with earlier transition of the wound to the reparative phase, a higher wound-healing rate, and fewer major amputations. The available data did not demonstrate a statistically significant effect on mortality.
 

Keywords

Diabetic Foot; Diabetic Neuropathies; Wound Healing; Platelet–Rich Plasma; Chronic Wound; Amputation; Diabetes Mellitus.

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