Effects Of Advanced Platelet-rich Fibrin On Patients With Chronic Wounds

Objective:Chronic wounds have complex etiology,long treatment cycle and high treatment costs.With the accelerated development of aging and the change of disease spectrum,chronic wounds have become a disease affecting people’s life and work in the new era.The advanced platelet-rich fibrin is a platelet concentrate prepared by low-speed and time-delay centrifugation of autologous venous blood,which had more loose fibrin structure,retained more platelets,white blood cells and growth factors,and had stronger anti-infection ability and promoting the regeneration potential of soft and hard tissues.In this study,the clinical efficacy of advanced platelet-rich fibrin(A-PRF)in the treatment of chronic wounds was investigated according to its biological characteristics of promoting soft tissue repair and regeneration.Methods:From December 2019 to December 2020,66 patients with chronic wounds who met the inclusion and exclusion criteria in two provincial tertiary hospitals were randomly divided into the control group and the experimental group.The control group was treated with conventional wound nursing,and the experimental group was treated with advanced platelet-rich fibrin on the basis of the control group.The healing time of chronic wounds,the frequency of dressing replacements,the reduction rate of wound area and the PUSH scores at the first,second and fourth weeks after intervention were compared between the two groups,and the study also evaluate the safety.Results:1.Implementation of the researchA total of 66 patients with chronic wounds were included in this study,33 cases in the control group and 33 cases in the experimental group.Three patients in the control group and one patient in the experimental group dropped out of the study,respectively,and 62 patients with chronic wounds completed the study.2.General informationThere were no significant differences in age,gender,BMI,wound area,duration of wound and wound type between the two groups(>0.05).3.Reduction rates of wound areaAt the first week of intervention,the respective median reduction rate of wound area in the experimental group and the control group was 22.13% and 18.75%.At the second week of intervention,the respective median reduction rate of wound area in the experimental group and the control group was 63.58% and 44.43%.At the 4th week of intervention,the median reduction rate of wound area in the experimental group and the control group was 90.76% and 80.85%,respectively.The results of the generalized estimation equation shows that there is an interaction between time and group(χ~2=6.09,<0.05),so need to control time effect and intergroup effect analysis of two groups of reduction rate of wound area.When the intergroup effect was controlled,the reduction rate of wound area at any two time points in the first week,the second week and the fourth week was statistically significant(<0.05);When time effect was controlled,there was no statistically significant difference in the reduction rate of wound area between the two groups at the first week(>0.05).At the second and fourth week,the area reduction rate of patients with chronic wounds in the experimental group was higher than that in the control group,with statistically significant differences(<0.05).4.PUSH scoresBefore the intervention,the median PUSH scores of experimental group and control group was 13.00 and 12.00.At the first week,the PUSH scores of the experimental group and the control group were 10.00 points.At the second week,the median PUSH scores of the experimental group and the control group was 7.00 and 8.00,respectively.At the fourth week,the median PUSH scores of the experimental group and the control group was 3.50 and 5.00,respectively.The results of the generalized estimation equation shows that there is an interaction between time and group(=19.47,<0.05),so need to control time effect and intergroup effect analysis of PUSH scores.When the intergroup effect was controlled,PUSH scores of patients in the two groups were statistically significant at any 2 time points in the 4 time points before intervention,the first week,the second week and the fourth week(<0.05);When controlling for time effect,there was no statistically significant difference in PUSH scores between the two groups before intervention and the first week(>0.05).At the second and fourth week,PUSH scores of patients with chronic wounds in the experimental group was lower than that in the control group,with statistically significant differences(<0.05).5.Healing time and frequency of dressing replacementThe mean healing time of patients with chronic wounds in the experimental group was(29.91±11.27)days,and the mean healing time of patients with chronic wounds in the control group was(37.37 ± 13.71)days,with the difference was statistically significant(<0.01).During the treatment,the median number of dressing replacements in the experimental group and the control group was 5 times and 9 times,and the difference was statistically significant(<0.01).6.Safety evaluationDuring the treatment,there were no adverse reactions such as abnormal hyperplasia of granulation tissue,deterioration and expansion of wound surface,allergy in the experimental group and the control group.Conclusion:The application of advanced platelet-rich fibrin in the treatment of chronic wounds can accelerate the healing of chronic wounds,shorten the healing time and reduce the frequency of dressing replacement,which was safe and effective.