Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

Mohammad Abbasi Tashnizi; Mohammad Esmail Khayami; Hamid Reza Rahimi; Aliasghar Moeinipour; Ahmad Amouzeshi; Alexander M. Seifalian; Daryoush Hamidi Alamdari

doi:10.4103/0970-0358.122011

Indian Journal of Plastic Surgery, Table of Contents

CC BY-NC-ND 4.0 · Indian J Plast Surg 2013; 46(03): 538-542
DOI: 10.4103/0970-0358.122011

Original Article

Association of Plastic Surgeons of India

Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

Authors

Mohammad Abbasi Tashnizi

Department of Cardiac Surgery, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Mohammad Esmail Khayami

Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Mashhad, Iran
Hamid Reza Rahimi

Student Research Committee, Department of Modern Sciences & Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Aliasghar Moeinipour

Department of Cardiac Surgery, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Ahmad Amouzeshi

Department of Cardiac Surgery, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Alexander M. Seifalian

Research Department of General Surgery, Division of Surgery and Interventional Science, UCL Centre for Nanotechnology & Regenerative Medicine, University College London, Royal Free Hampstead NHS Trust Hospital, London, UK
Daryoush Hamidi Alamdari

Stem cell and Regenerative Medicine Research Group, Department of Clinical Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

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ABSTRACT

Introduction: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG); but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. Materials and Methods: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. Results: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. Conclusions: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery.

KEY WORDS

Chronic wounds - fibrin glue - platelet-rich plasma - sternal wound

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References

1 Sharma RK, John JR. Role of stem cells in the management of chronic wounds. Indian J Plast Surg 2012;45:237-43.
2 Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, et al. Human skin wounds: A major and snowballing threat to public health and the economy. Wound Repair Regen 2009;17:763-71.
3 Harding KG, Morris HL, Patel GK. Science, medicine and the future: Healing chronic wounds. BMJ 2002;324:160-3.
4 Ravari H, Hamidi-Almadari D, Salimifar M, Bonakdaran S, Parizadeh MR, Koliakos G. Treatment of non-healing wounds with autologous bone marrow cells, platelets, fibrin glue and collagen matrix. Cytotherapy 2011;13:705-11.
5 Schimmer C, Sommer SP, Bensch M, Leyh R. Primary treatment of deep sternal wound infection after cardiac surgery: A survey of German heart surgery centers. Interact Cardiovasc Thorac Surg 2007;6:708-11.
6 Juhl AA, Koudahl V, Damsgaard TE. Deep sternal wound infection after open heart surgery - Reconstructive options. Scand Cardiovasc J 2012;46:254-61.
7 Silver FH, Wang MC, Pins GD. Preparation and use of fibrin glue in surgery. Biomaterials 1995;16:891-903.
8 Kachel E, Callum J, Moussa F, Goldstein J, Fremes S. Treatment of deep sternal wound infections after coronary artery bypass grafting by means of injection of platelet gel: An evolving technology. J Thorac Cardiovasc Surg 2010;139:e118-20.
9 Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: From basic science to clinical applications. Am J Sports Med 2009;37:2259-72.
10 Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Król W, Wielkoszynski T. Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: An in vitro study. J Bone Joint Surg Br 2007;89:417-20.
11 Tang YQ, Yeaman MR, Selsted ME. Antimicrobial peptides from human platelets. Infect Immun 2002;70:6524-33.
12 Laurens N, Koolwijk P, de Maat MP. Fibrin structure and wound healing. J Thromb Haemost 2006;4:932-9.
13 Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA. Effectiveness of platelet releasate for the treatment of diabetic neuropathic foot ulcers. Diabetes Care 2001;24:483-8.
14 Crovetti G, Martinelli G, Issi M, Barone M, Guizzardi M, Campanati B, et al. Platelet gel for healing cutaneous chronic wounds. Transfus Apher Sci 2004;30:145-51.
15 Driver VR, Hanft J, Fylling CP, Beriou JM, Autologel Diabetic Foot Ulcer Study Group. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage 2006;52:68-70, 72, 74 passim.
16 Jeong SH, Han SK, Kim WK. Treatment of diabetic foot ulcers using a blood bank platelet concentrate. Plast Reconstr Surg 2010;125:944-52.
17 Chen TM, Tsai JC, Burnouf T. A novel technique combining platelet gel, skin graft, and fibrin glue for healing recalcitrant lower extremity ulcers. Dermatol Surg 2010;36:453-60.
18 Sell SA, Ericksen JJ, Reis TW, Droste LR, Bhuiyan MB, Gater DR. A case report on the use of sustained release platelet-rich plasma for the treatment of chronic pressure ulcers. J Spinal Cord Med 2011;34:122-7.