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COMMENTARY
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 20-21

Expert comments on “autologous platelet-rich plasma for treatment of ischemic ulcers in buerger's disease”


Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK

Date of Web Publication31-Jan-2018

Correspondence Address:
Mr. Yiewfah Fong
Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, England
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_74_17

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How to cite this article:
Fong Y. Expert comments on “autologous platelet-rich plasma for treatment of ischemic ulcers in buerger's disease”. Indian J Vasc Endovasc Surg 2018;5:20-1

How to cite this URL:
Fong Y. Expert comments on “autologous platelet-rich plasma for treatment of ischemic ulcers in buerger's disease”. Indian J Vasc Endovasc Surg [serial online] 2018 [cited 2020 May 29];5:20-1. Available from: http://www.indjvascsurg.org/text.asp?2018/5/1/20/224457



In this issue, Dhananjaya Sharma et al. reported the early outcome of a case series of 14 patients diagnosed with Buerger's disease, being treated with autologous platelet-rich plasma (PRP).[1] They have concluded that PRP improved healing and is an effective treatment for pain.

There has been a Cochrane Review of PRP in the treatment of chronic wound that has not shown conclusive evidence that PRP is effective.[2] This paper, however, describes the first use of PRP in Buerger's disease. PRP is a term that describes plasma concentrate that is rich in platelets, although centrifugation is the most common method of preparing PRP,[3] there is currently no standardized preparation technique. This has led to the classification of PRP with two main key parameters – presence of cell contents and fibrin architecture.[4] Depending on the preparation method used, one of four family of PRP can be produced. Hence, not all PRPs are the same; therefore, outcome comparison can be difficult.

The authors classified cases according to the Rutherford and Society for Vascular Surgery (SVS) WIfI system. The concept of using WIfI for Buerger's disease is new as Buerger's disease is not included in the SVS WIfI system.[5] The authors argued that the factors present in threatened diabetic foot infection also present in Buerger's disease, hence the utilization of it. This study, however, did not demonstrate a correlation between WIfI classification and the outcome; it is, however, worth bearing in mind that this is a pilot study with a small sample size.

Two main aspects of the study relate to ulcer healing and pain relive. The severity of pain was recorded on a visual analog scale. Pain score was recorded on day 1, 5, and 10 but assumed to be at a maximum of 10 on day 0. The improvement of pain was measured against this baseline. There is an inherent bias in this method resulting in the over estimation of the analgesic effect of PRP.

With regards to ulcer healing, a grading system of 25 percentage point was used to measure healing. This method is simpler, one wonders if objective measurement of ulcer size, that is, surfaced area would have provided more detailed data for analysis.

The link between smoking and Buerger's disease is well documented.[6] The effect of Buerger's disease is more profound in South Asia where young patients are disproportionally affected within a challenging health economics. The prospect of a nonsurgical, autologous biological treatment, which can be administered in an outpatient setting, should be explored with enthusiasm. This pilot study concluded positive outcome for both wound healing and pain reduction, it is hope that this can be confirmed in larger study and demonstrates the benefit of PRP in addition to smoking cessation.



 
  References Top

1.
Dhananjaya Sharma PA, Jain S, Kothari R. Autologous platelet-rich plasma for treatment of ischemic ulcers in Buerger's disease: A pilot study with short-term results. Indian J Vasc Endovasc Surg 2018;5:14-20.  Back to cited text no. 1
    
2.
Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, et al. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev 2016;25(5):CD006899.  Back to cited text no. 2
    
3.
Bielecki T, Dohan Ehrenfest DM. Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF): Surgical adjuvants, preparations for in situ regenerative medicine and tools for tissue engineering. Curr Pharm Biotechnol 2012;13:1121-30.  Back to cited text no. 3
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4.
Dohan Ehrenfest DM, Andia I, Zumstein MA, Zhang CQ, Pinto NR, Bielecki T, et al. Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: Current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J 2014;4:3-9.  Back to cited text no. 4
    
5.
Mills JL Sr., Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014;59:220-340.  Back to cited text no. 5
    
6.
Lawrence PF, Lund OI, Jimenez JC, Muttalib R. Substitution of smokeless tobacco for cigarettes in Buerger's disease does not prevent limb loss. J Vasc Surg 2008;48:210-2.  Back to cited text no. 6
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