Autologous agent: Platelet gel shows promise of enhanced wound closure in healthy patients

NATIONAL REPORT — Could a by-product of multicomponent pheresis developed over three decades ago now be used as an agent to improve normal wound healing? Autologous platelet gel (APG) from healthy individuals may be such an agent to enhance quick, complete wound healing, according to findings from a recent report in the Archives of Facial Plastic Surgery.

In a preliminary pilot study, the use of APG on full-thickness skin punch wounds showed promise in its healing ability, according to lead author David B. Hom, M.D. APG was assessed in eight healthy men and women older than 21 years of age; it was applied to five 4-mm skin punch wounds made 3 cm apart on both upper thighs of all participants. By comparing the use of APG on one leg with the treatment of antibiotic ointment and/or occlusive dressings on the alternate thigh over a six-month period, the sites treated with the platelet gel had statistically increased wound closure compared with controls.

"We saw an up to 15 percent increase in closure rates in healing compared with controls," says Dr. Hom, director, Facial Plastic and Reconstructive Surgery, professor, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery at the University of Cincinnati Academic Health Center. "When the platelet gel concentrate was greater than six-fold, we saw the most pronounced healing."

PRESENT POSSIBILITIES As a therapeutic agent derived from a patient's own blood and converted into a concentrated plasma that is packed with platelets to render a gel applied directly to wounds, APG has shown efficacy in various specialties including orthopedic and oral surgery. With its proven wound healing abilities, new technology is expediting the retrieval and processing of a patient's blood for use in various surgical procedures.

"I have been using [APG] primarily on facelifts and abdominoplasty," says Gregory Wiener, M.D., a plastic surgeon at Resurrection Medical Center in Chicago. "In those cases where a vascularized flap is lifted and repositioned, you've created a dead space that needs to heal. By applying the platelet gel to these areas, I'm seeing an increased recovery rate and decreased complication rate."

Approached over a year ago by Chicago-based Midwest Circulatory Solutions, Dr. Wiener began using services that provide a trained technician to withdraw a patient's blood and process it to produce the platelet gel for application. The overall process takes approximately 40 minutes and is an out-of-pocket expense for the patient. Yet up to 70 percent of Dr. Wiener's patients are opting to pay the extra $900 it takes to improve their overall surgical experience.

"The final results are going to be the same, but the inflammatory phase and the length of the healing process may be decreased by days or possibly a week," Dr. Wiener tells Cosmetic Surgery Times . "The types of complications that are decreasing from the use of platelet gel are hematomas, or more frequently seromas — especially those resulting from tummy tucks. It seems to decrease these risks due to the sealing effect it offers."

CURRENT CAVEATS By applying only 10 cm³ of platelet gel per procedure to decrease inflammation, bruising and accmulation of excess fluid, platelet gel technology seems destined to find its place among cosmetic procedures. Yet, according to Debra A. Reilly, M.D., doctors should be cautious, especially with patients whose wound healing ability is compromised. While she admits to faster healing of skin grafts she completed on a frostbite patient, her concerns are the additional OR and anesthesia time required to complete the additional procedure, time that may be too valuable for those with wound healing problems.