Biomedical papers, 2014 (vol. 158), issue 2

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(2):242-258 | 10.5507/bp.2013.070

Addition of platelet concentrate to Dermo-Epidermal Skin Graft in deep burn trauma reduces scarring and need for revision surgeries

Vaclav Prochazkaa, Hana Klosovab, Jiri Stetinskyb, Jaromir Gumulecc, Katerina Vitkovad, Dana Salounovae, Jana Dvorackovaf, Hana Bielnikovaf, Petr Klementg†, Veronika Levakovah, Tomas Ocelkai, Lubomir Pavliskaj, Pavel Kovanick, Giannoula Lakka Klementl,m,n
a Institute of Radiodiagnostic and Vice-President for Science and Research, University Hospital Ostrava, Czech Republic
b Burn centre, University Hospital Ostrava
c Institute of Clinical Hematology, University Hospital Ostrava
d Department of Vice-President for Science and Research, University Hospital Ostrava
e Department of Mathematical Methods in Economy, VSB-Technical University of Ostrava
f Institute of Pathology, University Hospital Ostrava
g Vice-rector for External Affairs, VSB-Technical University of Ostrava
h Complex Oncologic centre, P&R Lab, Novy Jicin
i Institute of Public Health Ostrava, Partyzanske nam. 7, 702 00 Ostrava,
j E&H services, Inc., Navratilova 1421/11, Prague
k Retired scientist from the Czech Academy of Sciences
l Pediatric Hematology Oncology, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
m Center of Cancer System Biology, Steward St. Elizabeth Health Center, Boston, MA, USA
n Tufts University School of Medicine, Boston, MA, USA

Backround. Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues.

Methods: We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses.

Results: We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings.

Conclusions: Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1-3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1-7 days), which normalized over the subsequent 7 and 90 days.

Keywords: deep burn trauma, dermo-epidermal skin graft, surgical debridement, necrectomy, autologous platelet concentrate (APC), human autologous thrombin (HAT), scarring, laser doppler perfusion imaging (LDPI), gnostic analysis

Received: January 31, 2013; Accepted: September 13, 2013; Prepublished online: September 27, 2013; Published: June 23, 2014


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