Evidence of topical use with platelet-rich plasma in diabetic ulcer

Introduction: Growth factors have been shown to play a role in the process of wound healing, the most common of them being platelet-derived growth factor (PDGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), transforming growth factor (TGF), and insulin-like growth factor (IGF). These growth factors have been used as an alternative in the topical treatment of wounds, showing highly satisfactory results especially a high frequency of healing and epithelization. Objective: The objective of this study was to review the scientific evidence regarding the results of the use of platelet-rich plasma (PRP) for the topical treatment of chronic leg ulcers. Methods:  A systematic literature review was performed according to the Cochrane Collaboration protocol. Study material: Clinical trials on the use of PRP for diabetic ulcer in humans, published and indexed in the Cochrane, Lilacs, Cinahal, Embase and PubMed databases until July 2007.  Data analysis: The data were analyzed in four phases: 1) characterization of the selection process of the studies; 2) characterization of the studies included; 3) evaluation of the quality and evidence of the studies included using a scale for the assessment of the grade of recommendation and level of evidence, and a scale for the assessment and control of variables (SACV) elaborated based on all controlled variables surveyed by the authors of the studies included in the systematic review, and 4) statistical analysis in which, after analysis of the randomized clinical trials included in the systematic review, those with a score of 3 points or higher on the Jadad scale were submitted to a meta-analysis. Results: Of the 45,781 publications recovered, 18 articles were included. The scientific quality of the 5 randomized clinical trials was evaluated. Studies S6 and S29 presented strong evidence according to the Jadad scale, are strongly recommended by the SACV, and positive results were reported with the use of PRP when compared to the respective control groups. In contrast, S25 and S32 reported no positive results with the use of PRP and were also classified as strongly recommended. Meta-analysis of these 5 randomized clinical trials showed that the use of PRP contributed to the healing process (95%CI: 2.70-41.40). Conclusion: This systematic review and meta-analysis showed that there is scientific evidence regarding favorable outcomes of the use of PRP for the treatment of diabetic ulcer. Despite the observation of positive results in terms of healing rate, confirming the effectiveness of this approach, the use of PRP for the treatment of chronic leg wounds cannot be considered an isolated factor since a multiprofessional treatment program for the patients studied was included in all studies analyzed