Mazzucco Laura, Balbo Valeria, Zingarelli Enrico Maria, Desilvestri Manuela, Marchioni Manuela, Perrero Luca, Pollis Francesca, Varvello Ilaria
Transfusion Medicine and Regeneration Medicine, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Front Bioeng Biotechnol. 2024 Jan 15;11:1279149. doi: 10.3389/fbioe.2023.1279149. eCollection 2023.
Biological dressings with non-transfusion blood components are among the treatments available for pressure ulcers (PUs). Biological dressings contain active concentrated pro-regenerative molecules that can modify and switch off local inflammatory pathways. This re-establishes the physiological homing, which results in healing. In our study, we used a biological component obtained by ultrafiltration of plasma-platelet concentrate: protein-enriched filtered platelet-rich plasma (PEF) with a higher platelet and higher plasma protein concentration. We tested whether treatment with PEF could improve healing in advanced-stage pressure ulcers with a large surface area. All the patients in this study had a surgical indication but were not able to undergo surgery for various reasons. Ten patients with severe neurological disability and advanced-stage sacral pressure ulcers were treated with allogenic PEF. The mean lesion surface area at T0 was 13.4 cm ( ± 9.8 SD). PEF was derived from allogenic plasma-platelet apheresis that had been pre-ultrafiltered with a ProSmart™ filter (Medica, Italy) to obtain a concentration after filtration of the plasma protein (12-16 g/dL) and platelet (1-1.2 x 10 microL). All cases showed a reduction in the surface area of the pressure ulcer and in the Pressure Ulcer Scale for Healing (PUSH) score. The mean reduction values at week 6 were as follows: -52% for surface area and -21% for PUSH. Rapid wound healing is fundamental to avoid infections and improve patients' quality of life. This blood component builds new tissue by creating a new extracellular matrix. This, in turn, promotes rapid restoration of the three-dimensional structure of the tissue necessary for healing deeper wounds. PEF shrinks the PU and improves its morphological features (reducing undermining and boosting granulation tissue). PEF also promotes tissue restoration, obtaining an optimal scar. It is a safe and feasible treatment, and these preliminary results support the use of PEF in the treatment of pressure ulcers. PEF dressings could be integrated in the standard treatment of advanced-stage PU.
含非输血血液成分的生物敷料是治疗压疮（PU）的可用方法之一。生物敷料含有活性浓缩促再生分子，可改变并关闭局部炎症通路。这重新建立了生理归巢，从而实现愈合。在我们的研究中，我们使用了通过对血浆 - 血小板浓缩物进行超滤获得的一种生物成分：富含蛋白质的过滤富血小板血浆（PEF），其血小板和血浆蛋白浓度更高。我们测试了用PEF治疗是否能改善大面积晚期压疮的愈合情况。本研究中的所有患者都有手术指征，但由于各种原因无法接受手术。10例患有严重神经功能障碍和晚期骶部压疮的患者接受了同种异体PEF治疗。T0时平均病变表面积为13.4平方厘米（±9.8标准差）。PEF源自同种异体血浆 - 血小板单采，该血浆 - 血小板单采已用ProSmart™过滤器（意大利Medica公司）进行预超滤，以获得过滤后血浆蛋白浓度为12 - 16克/分升和血小板浓度为1 - 1.2×10微升的产物。所有病例的压疮表面积和愈合压疮量表（PUSH）评分均降低。第6周时的平均降低值如下：表面积降低52%，PUSH评分降低21%。快速伤口愈合对于避免感染和提高患者生活质量至关重要。这种血液成分通过创建新的细胞外基质来构建新组织。反过来，这又促进了愈合较深伤口所需组织三维结构的快速恢复。PEF可缩小压疮并改善其形态特征（减少潜行并促进肉芽组织生长）。PEF还促进组织修复，形成最佳瘢痕。这是一种安全可行的治疗方法，这些初步结果支持将PEF用于治疗压疮。PEF敷料可纳入晚期PU的标准治疗中。
