PRP therapy offers hope to chronic ulcer patients

PUNE: Sixty-five-year-old Subhash, a diabetic, accidentally hurt the sole of his right foot a decade ago. The wound gradually increased in size and depth, despite treatment, regular dressing and maintaining adequate blood sugar control.
Over the years, the skin of the sole thickened, lost considerable nerve sensation and a yellowish foulsmelling discharge started oozing out of the wound site.
After suffering for over a decade, Subhash got to know about platelet rich plasma (PRP) therapy (see box), which not just healed the festering wound within a month, but also helped him resume his normal routine.
Experts said PRP therapy has emerged as a new ray of hope for patients suffering from chronic ulcers as most of the foot amputations are preceded by ulceration. However, experts added, the therapy could benefit only a carefully selected patients of chronic ulcers.
“It has been a decade now that the PRP therapy has come to be used for treatment of chronic ulcers among patients with diabetes, vascular diseases, leprosy and trauma among others. However, it is still an underutilized therapy in India because of lack of awareness,” dermatologist Atika Agrawal said.
“Most of the clinical trials conducted in India and abroad have shown promising results of PRP therapy in more than 90% patients of chronic ulcers. After treating with this therapy, chances of recurrence are negligible once the healing is complete,” she said.
Agrawal has been treating about 100-120 patients with chronic ulcers every year. “Among the treated patient, 90% showed complete healing in just a single sitting, 5% required two to three sittings, while remaining 5% didn’t show any results for various reasons,” she added.
Chronic non-healing ulcers are a long standing raw areas/wounds on the skin associated with the disintegration of the tissue, commonly seen on lower legs.
“They are tough to treat or heal because of loss of blood flow or blood supply (vascularity) in the affected area and death of repairing cells. The PRP therapy provides growth factors and environment required for remodelling and regeneration of new tissues,” Agrawal said.
Orthopaedic surgeon Abhijit Joshi, who is fellowship-trained in diabetic foot surgery from National University Hospital (NUH) in Singapore, said PRP should be used in a very carefully selected patients.
“It is not a panacea. Its indiscriminate use as a treatment for diabetic foot ulcers should be carefully weighed,” Joshi said, adding that the level-one study about PRP used in diabetic foot ulcers had shown inconclusive results.
Joshi has also been treating patients with diabetic foot ulcers in Pune for the last 13 years.