PRP Application prior to Resurfacing with Split Thickness Skin Graft Vs Conventional Mechanical Fixation Using Sutures and Staples
A split thickness skin graft is generally done for soft skin coverage in view of its broad application for use due to ease of harvest. The healing process is undertaken through three stages anchorage, inosculation and maturation.
The application of autologous platelet-rich plasma (PRP) to the split-thickness skin graft sites is considered and theorized to provide immediate skin graft anchorage. Autologous PRP helps to achieve stable hemostasis as it mimics the final steps of the coagulation cascade.
A randomized control study in 40 patients for 24 months from October 2015 to September 2017 was conducted by Subha Dhua and colleagues at the Plastic Surgery Department at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Twenty patients in control and 20 in PRP groups were admitted. Freshly prepared autologous PRP was applied on wound beds in the treated group, while conventional mechanical fixation methods like staples and sutures were used in the control group for the fixation of the skin grafts. The wounds were surgically debrided, hemostasis was secured and lavage was done for both the selected groups. After the wound beds were prepared, topical application of the harvested PRP was done and the SSGs were placed over the recipient site. Freshly prepared autologous PRP was applied on wound beds in the treated group, while conventional mechanical fixation methods like staples and sutures were used in the control group for the fixation of the skin grafts. The inspection of the graft was carried out during the early postoperative period.
The entire procedure was aimed at the application of platelet-rich plasma in surgery prior to resurfacing with a skin graft for facilitating instant and stable adhesion of the SSG to the wound bed without any mechanical fixation. The results clearly showed considerable benefits including hemostasis, speeding up of operating time, frequency of postoperative dressings and the time of the surgery. Platelet activation plays a major role in exocytosis, cytoplasmic α degranulation with a significant burst of growth factor, platelet, derived growth factor, epidermal growth factor, platelet-derived growth factor as well as a vascular endothelial growth factor.
The cosmetic appearance of this scar was better in the PRP group besides post-operative edema and graft loss. The study recommends the use of PRP at the recipient site of split-thickness skin graft