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Keywords

autologous platelet-rich plasma, Fournier gangrene, necrotizing fasciitis, necrotizing soft tissue infection, split-thickness skin graft, thrombin gel

 

Authors

  1. Hersant, Barbara MD
  2. SidAhmed-Mezi, Mounia PhD
  3. Bosc, Romain MD
  4. Meningaud, Jean-Paul MD, PhD

ABSTRACT

BACKGROUND: Managing cutaneous substance loss after debridement is challenging, especially if it is secondary to necrotizing soft tissue infection, such as necrotizing fasciitis and Fournier gangrene. After skin graft reconstruction, the healing process is longer and may be difficult, depending on the wound site, skin defect size, and patient comorbidities.

 

OBJECTIVE: The aim of this study was to investigate whether autologous platelet-rich plasma (A-PRP) could accelerate and improve wound healing after cutaneous reconstruction for tissue loss secondary to soft tissue infection.

 

METHODS AND MATERIALS: A prospective, controlled, randomized, open-label study was conducted. Patients (N = 27) were randomized into 2 groups by drawing lots using sealed envelopes: an experimental (n = 14) and a control group (n = 13). Initially, all the necrotic tissue was extensively debrided and excised. In the experimental group, patients underwent a split-thickness skin graft (STSG) combined with A-PRP/thrombin gel sprayed on the wound bed and on the STSG after staple fixation. In the control group, patients underwent an STSG alone.

 

RESULTS: Results showed that the mean complete healing time was significantly reduced (by almost 50%) when A-PRP/thrombin gel was combined with an STSG compared with STSG alone (37.9 [SD, 14.3] days in the experimental group vs 73.7 [SD, 50.84] days in the control group, P = .01). No patient experienced complications during the follow-up period.

 

CONCLUSION: The combination of A-PRP/thrombin gel and an STSG significantly improved clinical outcomes and shortened the wound healing time. Therefore, this treatment combination could provide a way to heal skin after a necrotizing soft tissue infection with minimal recovery time.