Recalcitrant Cutaneous Ulcer of Comorbid Patient Treated with Platelet Rich Plasma: A Case Report
On November 25, 2011, a 94 yr-old woman was referred for the management of erythematous to violaceous patches with bullae on dorsum of left foot. She repeatedly hit her left foot in which intravenous line was situated with the opposite side for days. She had a various underlying disease including Alzheimer's dementia, angina pectoris, type 2 diabetes, hypertension, chronic kidney disease (stage IV) and was in a bed ridden state. Because of the poor oral intake and noncompliance to the Levin-tube, the percutaneous endoscopic gastrostomy tube had been inserted on her abdomen and only minimal amount of nutrition was maintained.\nDespite of the daily simple dressing and intermittent debridement about 2 weeks, the status of the wound was deteriorated and advanced to painful ulcerative patches with eschar and granulation tissues (). The results of the bacterial culture and gram stain were negative.\nAutologous PRP were prepared for the alternative management of her worsening wound. 12 mL peripheral autologous blood was obtained and collected into tubes containing acid-citrate-dextrose solution formula (ACD-A) anticoagulant. The citrated blood was centrifuged for 7 min at 2,500 rpm. Subsequently, the yellow plasma (containing buffy coat with platelets) was separated from other components. The upper 3 to 4 mL plasma called platelet poor plasma was removed by micropipette. The remnant PRP was extracted by sleeve filter and mixed with CaCl2. Finally, The CaCl2-activated PRP was topically applied to the ulcerative wound.\nThe patient underwent a total of 7 PRP treatments over a span of 8 weeks (performed twice a week until 5th treatment and then weekly until 7th treatment). As described above, these treatments involved topically application of activated PRP as well as packing of the wound with aseptic film for the sustained effect of growth factors. The film was removed on next day and the top layer was covered with hydrofoam dressing material until subsequent PRP treatment.\nOver the course of the PRP treatment, the wound became noticeably vascularized and filled with granulation tissue. The results of the changes in wound surface area and depth are shown in . The wound was essentially filled in with granulation tissue after seven PRP treatments with only subtle epithelialization of the new tissue remaining. There were neither signs of infection and allergic reaction nor discomfort of the patient during the treatment. After 2 months from the last (7th) treatment, the complete epithelialization was seen and no further simple dressing was required for the wound.