Role of Platelet Rich Fibrin Matrix (PRFM) in the Management of Non-Healing Ulcer

Non-healing wounds present significant clinical challenges and often require innovative therapeutic approaches. Platelet-Rich Fibrin Matrix (PRFM) has emerged as a promising treatment due to its ability to release growth factors that promote tissue repair and regeneration. This study aims to evaluate the effectiveness of PRFM in the management of non-healing ulcers and to explore its impact on wound healing.

Keywords: Platelet rich fibrin matrix (PRFM); wound management.

Chronic ulcers and other types of damaged wounds create a significant economic, social, and public health burden that continues to grow as the population ages. Platelet-derived growth factors play a crucial role in tissue remodeling, particularly in neovascularization. Over the past four decades, platelet-rich plasma (PRP) has been extensively studied and utilized. Platelet-rich fibrin matrix (PRFM) is an advanced form of autologous platelet therapy that shows great promise across various medical specialties. In cosmetic medicine, PRFM is effective for wound healing and skin rejuvenation, both as a primary treatment and as an adjunct, thanks to its fibrin structure, cellular elements, and sustained release of growth factors [1].

A study conducted in the Department of Plastic Surgery in a tertiary care center in South India. The patient was a 15-year-old male with history of post burn contracture who underwent contracture release following which he developed a non-healing ulcer over the dorsum of right foot. Regenerative therapy was administered using Platelet Rich Fibrin Matrix (PRFM), which was prepared in the following manner:

• 10 millilitres of the patient’s whole blood were drawn from the left antecubital vein into a sterile vial without anticoagulant.
• The blood was centrifuged at 3600 rpm for 20 minutes, resulting in three layers: an upper, straw-coloured platelet-poor plasma (PPP), a middle layer containing Platelet Rich Fibrin Matrix (PRFM), and a lower layer containing red blood cells (RBCs).
• The upper PPP layer was discarded, and the PRFM was carefully separated from the RBCs at the bottom using sterile forceps and scissors, leaving a small layer of RBCs about one millimetre thick.
• This PRFM was then placed on sterile gauze, transferred to the wound area, and covered with a two-layer regenerative scaffold, followed by sterile dressing and splinting.

This study demonstrates the use of PRFM in wound bed preparation for a non-healing ulcer. Notably, the ulcer showed a reduction in size following the application of PRFM.

The migration, proliferation, and functions of keratinocytes, fibroblasts, and endothelial cells are supported by the release of cytokines and growth factors from platelets.2 Chronic wounds experience a delay in the inflammatory stage of recovery. Non-healing ulcers fail to recover due to a lack of essential growth factors. These growth factors are derived from platelets and can be found in Platelet Rich Plasma (PRP), Platelet Rich Fibrin (PRF), and Platelet Rich Fibrin Matrix (PRFM). Applying therapies based on platelet-rich plasma can be beneficial in promoting healing. Fibrin, a functional variant of fibrinogen, plays a key role in this process [3].

Thrombin plays a key role in platelet aggregation by converting fibrinogen into insoluble fibrin. Since platelet concentrates often lack coagulation factors, Platelet-Rich Fibrin Matrix (PRFM) was developed to enhance tissue regeneration and wound healing. During centrifugation, fibrinogen accumulates in the upper portion of the tube, where it combines with thrombin to form a fibrin clot. Growth factors begin to release 5–10 minutes after clotting and continue for at least 60–300 minutes, ensuring a slow, sustained release. This process results in a polymerized tetramolecular fibrin matrix gel that combines platelets, leukocytes, cytokines, and circulating stem cells to aid in healing [4].

Platelet-Rich Fibrin Matrix (PRFM) is derived from blood without any biochemical interference, offering a long-term release of growth factors that promote tissue repair and regeneration. In a study by Mirhaj et al., Leucocyte- and Platelet-Rich Fibrin (L-PRF) and Advanced Platelet-Rich Fibrin (A-PRF) were extracted and incorporated into nanofibers containing polyacrylamide (PAAm), PAAm/L-PRF, and PAAm/A-PRP using an electrospinning technique. The study thoroughly assessed how different types of PRFM affect the physical, mechanical, and biological properties of the nanofibrous wound dressings. The findings revealed that incorporating L-PRF significantly reduced fibre diameter, enhanced mechanical properties, and increased the degradation rate compared to the A-PRF group. Furthermore, the PAAm/A-PRF nanofibers showed improved cell proliferation, adhesion, angiogenesis potential, and wound healing abilities, attributed to the release of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). Overall, both L-PRF and A-PRF enhanced the physical, mechanical, and biological characteristics of the nanofibers, making them promising candidates for wound dressings, particularly for applications in skin tissue repair and regeneration [5].

Figure 1: Centrifuged sample with 3 layers

Figure 2: Platelet rich fibrin Matrix (PRFM)

Figure 3: PRFM being applied to the wound

In our study, we utilized this knowledge of PRFM application for wound healing and observed positive outcomes.

PRFM led to relatively quicker healing of ulcers. While this is a preliminary study, further randomized controlled trials are necessary to validate the effectiveness of PRFM in managing non-healing wounds in the future.

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