No. 3 Department of Burns and Plastic Surgery and Wound Healing Center, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Wound Repair Regen. 2021 Jan;29(1):153-167. doi: 10.1111/wrr.12874. Epub 2020 Nov 10.
Sternal wound infection (SWI) is a devastating complication after cardiac surgery. Platelet-rich plasma (PRP) may have a positive impact on sternal wound healing. A systematic review with meta-analyses was performed to evaluate the clinical effectiveness of topical application of autologous PRP for preventing SWI and promoting sternal wound healing compared to placebo or standard treatment without PRP. Relevant studies published in English or Chinese were retrieved from the Cochrane Central Register of Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of Science, Springer Link, and the WHO International Clinical Trials Registry Platform (ICTRP) using the search terms "platelet-rich plasma" and "sternal wound" or "thoracic incision." References identified through the electronic search were screened, the data were extracted, and the methodological quality of the included studies was assessed. The meta-analysis was performed for the following outcomes: incidence of SWI, incidence of deep sternal wound infection (DSWI), postoperative blood loss (PBL), and other risk factors. In the systematic review, totally 10 comparable studies were identified, involving 7879 patients. The meta-analysis for the subgroup of retrospective cohort studies (RSCs) showed that the incidence of SWI and DSWI in patients treated with PRP was significantly lower than that in patients without PRP treatment. However, for the subgroup of randomized controlled trials (RCTs), there was no significant difference in the incidence of SWI or DSWI after intervention between the PRP and control groups. There was no significant difference in PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in-situ recurrences were reported. According to the results, PRP could be considered as a candidate treatment to prevent SWI and DSWI. However, the quality of the evidence is too weak, and high-quality RCTs are needed to assess its efficacy on preventing SWI and DSWI.
胸骨伤口感染（SWI）是心脏手术后一种破坏性的并发症。富含血小板的血浆（PRP）可能对胸骨伤口愈合有积极影响。进行了系统评价和荟萃分析，以评估与安慰剂或无 PRP 的标准治疗相比，局部应用自体 PRP 预防 SWI 和促进胸骨伤口愈合的临床效果。使用“富含血小板的血浆”和“胸骨伤口”或“胸部切口”等检索词，从 Cochrane 中央对照试验注册库（Cochrane Library）、PubMed、Ovid EMBASE、Web of Science、Springer Link 和世界卫生组织国际临床试验注册平台（ICTRP）检索到发表于英文或中文的相关研究。通过电子搜索确定的参考文献进行了筛选，提取了数据，并评估了纳入研究的方法学质量。对以下结局进行了荟萃分析：SWI 发生率、深部胸骨伤口感染（DSWI）发生率、术后失血（PBL）和其他危险因素。在系统评价中，共确定了 10 项具有可比性的研究，涉及 7879 名患者。对回顾性队列研究（RCS）亚组的荟萃分析表明，PRP 治疗组患者的 SWI 和 DSWI 发生率明显低于无 PRP 治疗组患者。然而，对于随机对照试验（RCT）亚组，干预后 PRP 组和对照组之间的 SWI 或 DSWI 发生率无显著差异。RCT 和 RCS 亚组的 PBL 无显著差异。均未报告不良反应或原位复发。根据结果，PRP 可被视为预防 SWI 和 DSWI 的候选治疗方法。然而，证据质量太差，需要高质量的 RCT 来评估其预防 SWI 和 DSWI 的疗效。
