Department of Plastic Surgery, Cambridge University NHS Trust, Cambridge, UK.
St Andrew's Anglia Ruskin (StAAR) Research Group, School of Medicine, Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, UK.
World J Surg. 2022 Dec;46(12):2910-2918. doi: 10.1007/s00268-022-06711-w. Epub 2022 Sep 5.
Pilonidal disease can be a debilitating condition which carries a significant physical and economic burden. This systematic review and updated meta-analysis presents the evidence for the use of platelet-rich plasma (PRP) for wound healing following open and minimally-invasive sacrococcygeal pilonidal surgery.
A literature search was performed during December 2021 for studies relating to platelet-rich plasma and pilonidal wound healing following surgery.
Nine studies remained after applying the exclusion criteria, incorporating a total of 621 (open surgery group) and 309 (minimally-invasive group) patients, respectively. Pooled analysis of the six open surgery group studies demonstrated a significant reduction in wound healing time (mean difference [MD] = - 13.98 days, 95% CI - 18.41 to - 9.55, p < 0.001, I = 98%). Three open surgery group studies compared post-operative time off work, while three recorded mean pain duration; pooled analysis also revealed a significant reduction in both outcomes, respectively (MD = - 8.7 days, 95% CI - 9.4 to - 8.0, p < 0.001, I = 57%; MD = - 9.5 days, 95% CI - 15.6 to - 3.3, p = 0.002, I = 98%). Methodological heterogeneity among the minimally-invasive studies precluded formal meta-analysis; however, two studies demonstrated a modest improvement in wound healing when treated with PRP.
This systematic review and updated meta-analysis provide further evidence supporting the use of PRP for wound healing in sacrococcygeal pilonidal disease. PRP application was demonstrated to significantly reduce healing time, postoperative pain and time off work in the open surgery group. Nevertheless, there is still considerable heterogeneity among PRP manufacture and administration techniques, and further high-powered RCTs with consistent methodology are required to substantiate these findings.
藏毛窦疾病可能是一种使人虚弱的疾病，给患者带来重大的身体和经济负担。本系统评价和更新的荟萃分析介绍了富血小板血浆（PRP）在开放性和微创性骶尾部藏毛窦手术后伤口愈合中的应用证据。
2021 年 12 月，我们对与手术后 PRP 与藏毛窦伤口愈合相关的研究进行了文献检索。
应用排除标准后，共有 9 项研究纳入分析，分别纳入了 621 例（开放性手术组）和 309 例（微创性手术组）患者。对 6 项开放性手术组研究进行的汇总分析显示，伤口愈合时间显著缩短（平均差值 [MD] = -13.98 天，95%置信区间 -18.41 至 -9.55，p < 0.001，I² = 98%）。3 项开放性手术组研究比较了术后停工时间，3 项研究记录了平均疼痛持续时间；汇总分析还分别显示这两个结果均显著改善（MD = -8.7 天，95%置信区间 -9.4 至 -8.0，p < 0.001，I² = 57%；MD = -9.5 天，95%置信区间 -15.6 至 -3.3，p = 0.002，I² = 98%）。微创性研究由于方法学异质性而无法进行正式的荟萃分析；然而，两项研究显示，用 PRP 治疗可适度改善伤口愈合。
本系统评价和更新的荟萃分析进一步提供了支持 PRP 用于骶尾部藏毛窦疾病伤口愈合的证据。PRP 应用可显著缩短开放性手术组的愈合时间、术后疼痛和停工时间。然而，PRP 的制备和给药技术仍存在较大的异质性，需要进一步进行具有一致方法学的高质量 RCT 来证实这些发现。
