| Background: Platelet-rich Fibrin(PRF)is a new type of biomaterial derived from autologous whole blood centrifugation and is known as a new generation of platelet concentrate.It is a reticular fibrin gel between the red blood cell debris layer and the platelet-poor plasma layer after centrifugation by autologous peripheral blood.PRF is rich in various high concentrations of growth factors,a large number of white blood cells,immune factors,etc.,and has an active role in anti-infection,wound healing and beauty.Like artificial dermis,PRF also has a three-dimensional fibrin network structure similar to that of human natural fibrin network.Its structure is looser than platelet plasma,and the gap is large and elastic.This structure combines with its growth factors.Slow release of growth factors,continuous induction of cell migration and tissue proliferation,longer-lasting effects of growth factors,accelerated tissue regeneration and wound healing,and PRF is an autologous biomaterial with simple extraction and high safety.At present,PRF has been widely used in oral and maxillofacial surgery,treatment of gingival atrophy and bone regeneration,and has achieved good results.However,there are relatively few studies on PRF to promote wound healing of tendon exposure.The authors performed this study to observe the clinical effect of PRF in treating tendon exposed wounds,and to compare the effects of artificial dermis and PRF on the treatment of tendon exposed wounds by randomized controlled method,in order to evaluate the effect of PRF on tendon exposed wounds.It is confirmed that PRF has a clinical positive effect on the healing process of tendon exposed wounds,and it is feasible and operable.Methods:From January 2017 to January 2018,36 patients(with or without infection)were selected according to the exclusion criteria for the patients with plastic surgery in the Department of Plastic Surgery,Second Affiliated Hospital of Anhui Medical University.The selected patients were unwilling Local flap or free flap treatment.The age,sex,and area of the exposed tendon were recorded and randomly divided into the artificial dermis group and the PRF group(18 cases in each group).All patients completed preoperative related laboratory tests and routinely used cephalosporin antibiotics.Those with positive bacterial cultures in wound secretions should use sensitive antibiotics according to the results of drug susceptibility.The patients with larger wounds should receive systemic support treatment.Those with poor nutrition should not be able to correct anemia and hypoproteinemia as soon as possible.All subjects were treated with debridement treatment in the first stage.Infected patients were treated with vacuum sealing drainage(VSD)to seal the infected wounds.After the wounds were cleaned,the artificial dermis was covered with artificial dermis.Then,VSD vacuum aspiration is used until the exposed tendon is covered by fresh blood vessels and granulation tissue,and then returned to the operating room for a mediumthickness skin graft.In the PRF group,a PRF gel prepared from blood collected from the median vein of the elbow was used to make a PRF membrane covering the exposed tendon,and then the VSD protective dressing was trimmed according to the size of the wound surface so as to completely cover the wound surface,and the exposed tendon was to be covered.After being covered by granulation tissue,the medium-thickness skin graft was transplanted.The growth rate of granulation tissue before skin grafting and the pain degree in the first five days after operation were recorded.The pain level was measured by fourpoint verbal rating scale(VRS-4).)Evaluation.Record the texture of the scar in the skin graft area three months after the patient's skin graft survived.Results: According to the measurement results,there were large areas of fresh granulation tissue coverage on the tendon of the two groups.The growth rate of granulation tissue in the artificial dermis group was lower than that in the PRF group(92.39 vs97.83 P <0.001).In the first five days after surgery,the pain scores of the PRF group were significantly lower than those of the artificial dermis group(P < 0.001).The pain in the PRF group showed a significant downward trend after the 8th hour after surgery.Most of the exposed tendons in the cleansing wound are covered by fresh granulation tissue.Within three months after surgery,the scores of the scars in the grafted area of the artificial dermis were higher than those in the PRF group(P< 0.001).Conclusion: PRF has a satisfactory clinical effect in the treatment of tendon exposed wounds that cannot be directly transplanted with skin grafts or flaps.It is rich in a large number of growth factors and immune cells,which accelerate the growth of granulation tissue at the exposed tendon compared with the artificial dermis,and improve the texture of scar tissue and adhesion with peripheral tissue after skin graft transplantation,with aesthetic effect,and significantly alleviate postoperative pain. |
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