Use of platelet-rich plasma and modified nanofat grafting in infected ulcers: Technical refinements to improve regenerative and antimicrobial potential

Background Surgical reconstruction of chronic wounds is often infeasible due to infection, comorbidities, or poor viability of local tissues. The aim of this study was to describe the authors’ technique for improving the regenerative and antimicrobial potential of a combination of modified nanofat and platelet-rich plasma (PRP) in nonhealing infected wounds.

Methods Fourteen patients met the inclusion criteria. Fat tissue was harvested from the lower abdomen following infiltration of a solution of 1,000 mL of NaCl solution, 225 mg of ropivacaine, and 1 mg of epinephrine. Aspiration was performed using a 3-mm cannula with 1-mm holes. The obtained solution was decanted and mechanically emulsified, but was not filtered. Non-activated leukocyte-rich PRP (naLR-PRP) was added to the solution before injection. Patients underwent three sessions of injection of 8-mL naLR-PRP performed at 2-week intervals.

Results Thirteen of 14 patients completed the follow-up. Complete healing was achieved in seven patients (53.8%). Four patients (30.8%) showed improvement, with a mean ulcer width reduction of 57.5%±13.8%. Clinical improvements in perilesional skin quality were reported in all patients, with reduced erythema, increased thickness, and increased pliability. An overall wound depth reduction of 76.6%±40.8% was found. Pain was fully alleviated in all patients who underwent re-epithelization. A mean pain reduction of 42%±33.3% (as indicated by visual analog scale score) was found in non-re-epithelized patients at a 3-month follow-up.

Conclusions The discussed technique facilitated improvement of both the regenerative and the antimicrobial potential of fat grafting. It proved effective in surgically-untreatable infected chronic wounds unresponsive to conventional therapies.

Keywords

Platelet-rich plasma - Anti-infective agents - Tissue grafts - Ulcer - Wounds

Publikationsverlauf

Eingereicht: 31. Oktober 2019

Angenommen: 10. April 2020

Artikel online veröffentlicht:
22. März 2022

• REFERENCES

• 1 Pourmoussa A, Gardner DJ, Johnson MB. et al. An update and review of cell-based wound dressings and their integration into clinical practice. Ann Transl Med 2016; 4: 457
• 2 Doi K, Ogata F, Eto H. et al. Differential contributions of graft-derived and host-derived cells in tissue regeneration/remodeling after fat grafting. Plast Reconstr Surg 2015; 135: 1607-17
• 3 Tabit CJ, Slack GC, Fan K. et al. Fat grafting versus adiposederived stem cell therapy: distinguishing indications, techniques, and outcomes. Aesthetic Plast Surg 2012; 36: 704-13
• 4 Tonnard P, Verpaele A, Peeters G. et al. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg 2013; 132: 1017-26
• 5 Kemaloglu CA. Nanofat grafting under a split-thickness skin graft for problematic wound management. Springerplus 2016; 5: 138
• 6 Eto H, Kato H, Suga H. et al. The fate of adipocytes after nonvascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg 2012; 129: \1081-92
• 7 Cervelli V, Gentile P, Scioli MG. et al. Application of platelet-rich plasma in plastic surgery: clinical and in vitro evaluation. Tissue Eng Part C Methods 2009; 15: 625-34
• 8 D’Esposito V, Passaretti F, Perruolo G. et al. Platelet-rich plasma increases growth and motility of adipose tissue-derived mesenchymal stem cells and controls adipocyte secretory function. J Cell Biochem 2015; 116: 2408-18
• 9 Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 2009; 27: 158-67
• 10 Tenna S, Cogliandro A, Barone M. et al. Comparative study using autologous fat grafts plus platelet-rich plasma with or without fractional CO2 laser resurfacing in treatment of acne scars: analysis of outcomes and satisfaction with FACE-Q. Aesthetic Plast Surg 2017; 41: 661-6
• 11 Khouri RK, Smit JM, Cardoso E. et al. Percutaneous aponeurotomy and lipofilling: a regenerative alternative to flap reconstruction?. Plast Reconstr Surg 2013; 132: 1280-90
• 12 Padoin AV, Braga-Silva J, Martins P. et al. Sources of processed lipoaspirate cells: influence of donor site on cell concentration. Plast Reconstr Surg 2008; 122: 614-8
• 13 Jurgens WJ, Oedayrajsingh-Varma MJ, Helder MN. et al. Effect of tissue-harvesting site on yield of stem cells derived from adipose tissue: implications for cell-based therapies. Cell Tissue Res 2008; 332: 415-26
• 14 Rohrich RJ, Sorokin ES, Brown SA. In search of improved fat transfer viability: a quantitative analysis of the role of centrifugation and harvest site. Plast Reconstr Surg 2004; 113: 391-7
• 15 Keck M, Zeyda M, Gollinger K. et al. Local anesthetics have a major impact on viability of preadipocytes and their differentiation into adipocytes. Plast Reconstr Surg 2010; 126: 1500-5
• 16 Sung SH, Lee JG, Yu SB. et al. The effects of lidocaine and procaine on microRNA expression of adipocyte-derived adult stem cells. Korean J Anesthesiol 2012; 62: 552-7
• 17 Breu A, Eckl S, Zink W. et al. Cytotoxicity of local anesthetics on human mesenchymal stem cells in vitro. Arthroscopy 2013; 29: 1676-84
• 18 Gugerell A, Kober J, Schmid M. et al. Botulinum toxin A and lidocaine have an impact on adipose-derived stem cells, fibroblasts, and mature adipocytes in vitro. J Plast Reconstr Aesthet Surg 2014; 67: 1276-81
• 19 Girard AC, Atlan M, Bencharif K. et al. New insights into lidocaine and adrenaline effects on human adipose stem cells. Aesthetic Plast Surg 2013; 37: 144-52
• 20 Alharbi Z, Oplander C, Almakadi S. et al. Conventional vs. micro-fat harvesting: how fat harvesting technique affects tissueengineering approaches using adipose tissue-derived stem/ stromal cells. J Plast Reconstr Aesthet Surg 2013; 66: 1271-8
• 21 Conde-Green A, Baptista LS, de Amorin NF. et al. Effects of centrifugation on cell composition and viability of aspirated adipose tissue processed for transplantation. Aesthet Surg J 2010; 30: 249-55
• 22 Kakudo N, Minakata T, Mitsui T. et al. Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts. Plast Reconstr Surg 2008; 122: 1352-60
• 23 Atashi F, Jaconi ME, Pittet-Cuenod B. et al. Autologous platelet-rich plasma: a biological supplement to enhance adipose-derived mesenchymal stem cell expansion. Tissue Eng Part C Methods 2015; 21: 253-62
• 24 Zhang LJ, Guerrero-Juarez CF, Hata T. et al. Innate immunity: dermal adipocytes protect against invasive Staphylococcus aureus skin infection. Science 2015; 347: 67-71
• 25 Miller LS. Adipocytes armed against Staphylococcus aureus. N Engl J Med 2015; 372: 1368-70