Bhanot Sumeet, Alex James C
Section of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.
Facial Plast Surg. 2002 Feb;18(1):27-33. doi: 10.1055/s-2002-19824.
The response of living tissue to injury is a central component in the planning of all surgical procedures. The wound-healing process is typically divided into three phases (inflammatory, proliferative, and remodeling) and is a complex process in which a multitude of cellular and humoral components interact to restore a wound defect. Platelets and their released cytokines and growth factors are pivotal in the modulation of this entire process. Although several techniques may be used to achieve hemostasis after initial injury, few initiate and actually accelerate tissue regeneration. Both platelet gel and fibrin glue are effective hemostatic agents. Platelet gels, unlike fibrin glue, have a high concentration of platelets that release the bioactive proteins and growth factors necessary to initiate and accelerate tissue repair and regeneration. In particular, two growth factors that play a major role in platelet gels are platelet-derived growth factor, a powerful chemoattractant, and transforming growth factor beta, which significantly increases and stimulates the deposition of extracellular matrix. In creating a platelet gel, autologous blood is centrifuged to produce a concentrate high in both platelets and plasma. This concentrate can be applied to wounds, providing hemostasis, adhesion, and enhanced wound healing. Recent techniques for the autologous concentrating process have been streamlined, and now platelet gels are clinically accessible to most physicians. Platelet gels have global applications in surgery and are especially useful for the soft tissue and bony reconstructions encountered in facial plastic and reconstructive surgery. In these applications, their use has been associated with a decrease in operative time, necessity for drains and pressure dressings, and incidence of complications. When applied to bony reconstruction it provides adhesion for the consolidation of cancellous bone and comminuted fracture segments.
活组织对损伤的反应是所有外科手术规划中的核心要素。伤口愈合过程通常分为三个阶段（炎症期、增殖期和重塑期），是一个复杂的过程，其中众多细胞和体液成分相互作用以修复伤口缺损。血小板及其释放的细胞因子和生长因子在整个过程的调节中起关键作用。尽管初始损伤后可采用多种技术实现止血，但很少有技术能启动并实际加速组织再生。血小板凝胶和纤维蛋白胶都是有效的止血剂。与纤维蛋白胶不同，血小板凝胶含有高浓度的血小板，可释放启动和加速组织修复与再生所需的生物活性蛋白和生长因子。特别是，在血小板凝胶中起主要作用的两种生长因子是血小板衍生生长因子（一种强大的趋化剂）和转化生长因子β，后者可显著增加并刺激细胞外基质的沉积。制备血小板凝胶时，将自体血液离心以产生富含血小板和血浆的浓缩物。这种浓缩物可应用于伤口，实现止血、黏附并促进伤口愈合。最近，自体浓缩过程的技术已得到简化，现在大多数医生在临床上都可获取血小板凝胶。血小板凝胶在外科手术中有广泛应用，尤其适用于面部整形和重建手术中遇到的软组织和骨重建。在这些应用中，其使用与手术时间缩短、引流和加压敷料需求减少以及并发症发生率降低相关。应用于骨重建时，它可为松质骨和粉碎性骨折段的巩固提供黏附作用。
