Platelet Rich Plasma PRP scientifically correct term Autologous

• Platelet Rich Plasma (PRP) scientifically correct term • Autologous Platelet Gel (APG) • Plasma Very Rich in Platelets (PVRP) -> acceptable for clinical usage • Plasma gel • Autogenous Hematopoetic Tissue Graft

Peripheral blood smear. Scattered platelets correlating to a peripheral blood platelet count of 225, 000 per ul PRP smear. Dense platelet concentration correlating to a platelet count of 1, 400, 000 per ul in a 5 ml volume

• Autologous platelet gel (APG) was developed in early 1990's as a byproduct of multicomponent pheresis • When platelet concentrate is combined with thrombin and calcium, a viscous coagulum (gel) is rapidly formed. • Initial successes lead to expanded applications where large blood losses were not typically encountered.

Platelets and Growth Factors • Since 1982, several studies have shown enhancement of in vitro tissue cultures are enhanced by addition of platelets. • Platelet derived wound healing factor (PDWHF), an extract of activated platelets, has been shown to enhance healing of cutaneous ulcers.

Component of platelet gel Growth factor components • PDGF (platelet derived growth factor) • TGF-αβ (Transforming growth factor alpha and beta) • EGF (Epidermal growth factor) • FGF (Fibroblast growth factor) • IGF (Insulin growth factor) • PDEGF (Platelet derived epidermal growth factor) • PDAF (Platelet derived angiogenesis factor) • IL-8 (Interleukin-8) • TNF-α (Tumor necrosis factor alpha) • CTGR (Connective tissue growth factor) • GM-CSF (Granulocyte macrophage colony stimulating factor) • KGF (Keratinocyte growth factor) • Histamines, Serotonin, ADP, Thromboxane A 2 and other vasoactive and chemotatic agents

Component of platelet gel cellular components of platelet gel • Platelets • Neutrophil (PMN) – 40 -75% of circulating leukocytes • Monocyte macrophage – 2 -10% of circulating leukocytes. Highly motile and migrate to soft tissue • Fibroblasts – produce collagen, reticular fibers, glycosaminoglycans, glycoprotein • Endothelial cell – permeability barrier, regulate blood flow and vascular reactivity, vasodilators, regulate inflammation and immunity • Keratinocyte – Stratified, squamous epithelial cells Primary function is to act as a barrier

Benefits of platelet rich plasma • Accelerate endothelial, epithelial and epidermal regeneration • Stimulate angiogenesis • Enhance collagen synthesis • Promotes enhanced soft tissue wound healing • Decreased dermal scarring • Enhanced hemostatic response • Reverse the inhibition of wound healing caused by glucocorticoids

Benefits of platelet rich plasma • Augmented rate of extracellular matrix deposition, resulting in earlier wound closure • Autologous blood product, with no risk of infectious disease transmission or clerical errors, thus making it a safe product • No time consuming visits to the blood bank for predonation. Sequester is done in the immediate preoperative period, and utilized perioperatively • Provides for an immediate surgical hemostatic agent that is biocompatible, effective and safe

사용방법 The Smart. PRe. P automated platelet concentrate system. 1> Loading the processing vessel. 2> Loading the processing vessel into the concentrate system. 3> Removing the processing vessel from the concentrate system after a 12 minute cycle. 4> Aspirating platelet-poor plasma from the processing vessel. 5> Mixing platelet concentrate. 6> Aspirating platelet-rich plasma.

Fibrin glue being applied to the surgical field by a dual syringe method. Surgical field with a layer of platelet gel applied.

Source - http: //www. perfusion. com/perfusion/prpdevicesummary. asp

Source - http: //www. perfusion. com/perfusion/prpdevicesummary. asp

• two groups - the standard care with platelet-rich plasma gel or control (saline gel) dressing group • significantly more platelet-rich plasma gel (13 out of 16, 81. 3%) than control gel (eight out of 19, 42. 1%) treated wounds healed (P = 0. 036)

2007 Biological Device Application Approvals by FDA

Platelet gel의 임상적 적용 Plastic Surgery: Face, Neck and Brow Lifts Endoscopic Brow Blephroplasty Facial Laser Procedures Breast Reconstruction, Reduction, Mammoplasty, and Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Abdominoplasty Cranio-Facial Reconstruction Non-Healing Wounds, Large & Small Fat Transfers Ears, Nose and Throat: Rhinoplasty, Thyroidectomy Parotidectomy, Accoustic Neuroma Head & Neck Cancers Tympanoplasty Fixation of Cartilage, Bone, or Artificial Implants Dura and Facia Grafting Skin Graft Fixation Local Hemostasis in Patients with Bleeding (Tonsillectomy, Adenoidectomy, Mucous Membrane Defects)

Platelet gel의 임상적 적용 Orthopaedic Surgery: Total Joint Replacement (Hips/Knees) Spinal Fusion Laminectomy Fractures, Non-Union/Bony Defects Oral Surgery, Peridontal, Dental Implant Surgery: Mandibular Reconstruction/Bone Grafts Le. Fort Fractures (Guerin's Fracture) Sinus Lifts/Naso-Alveolar Repair Dental Implants General Surgery: Hepatic Lobectomy/Wedge Pancreatic Surgery/Whipple Procedure Enterocutaneous Fistulas Mastectomy/Axillary Dissection Neurosurgery: Craniotomy Transphenoidal Hypophysectomy Pituitary Tumor Dural Repair LP Shunt/Cerebrospinal Fluid Leak

Platelet gel의 임상적 적용 Urology: Hemi-Nephrectomy Retroperitoneal Tumor Radical Retropubic Prostatectomy Major Vascular Surgery: Abdominal Aortic Aneurysm/AFB Carotid Endarterectomy Vascular Access Grafts Cardio-Thoracic Surgery: Coronary Artery Bypass Grafting (CABG) Valve Repair/Replacement Bronchopleural Fistula Aneurysm Repair Sternal Repairs Cardio-Thoracic Redo Surgery Chronic Wounds: Decubitis Ulcers Venostasis Ulcers Diabetic Foot Ulcers Spider Bites