April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Aesth Plast Surg (2015) 39:495–505

P-PRP-treated side showed thicker collagen bundles [ 54 ]. Shin et al. compared combining fractional laser treatment with P-PRP with laser alone. This study found that P-PRP combined with fractional laser increased subject satisfac- tion and skin elasticity and decreased the erythema index. P-PRP treatment also increased the length of the der- moepidermal junction, the amount of collagen, and the number of fibroblasts [ 55 ]. Kim and Gallo injected PRFM subcutaneously into skin treated with fractional ablative CO 2 laser and noted small but statistically significant de- creases in edema and erythema postoperatively, but no difference in the reepithelialization rate [ 56 ]. Chignon-Sicard et al. looked at use of L-PRF in healing of hand wounds. A single L-PRF application on fresh postoperative hand wounds was associated with faster reepithelialization, with a median improvement of 5 days to the standard treatment of 29 days [ 57 ]. Four studies specifically looked at effect of platelet preparations on hair loss. Sclafani showed that a series of intradermal injections of autologous platelet-rich fibrin matrix increased the hair density index in patients with androgenetic alopecia at 2 and 3 months after initial treatment; this improvement approached statistical sig- nificance at 6 months after initiating treatment [ 58 ]. Schi- avone et al. performed scalp injections of L-PRP on 64 patients at baseline and at 3 months and evaluated patients photographically. Some improvement was seen in all or most patients by evaluators at 6 months [ 59 ]. Cervelli et al. injected PRFM every month for 3 months into half of se- lected patients’ scalps with hair loss. They found an in- crease in mean number of hairs and a mean increase in total hair density [ 60 ]. Khatu et al. also performed a series of injections of P-PRP and found an increase in hair counts at 12 weeks [ 61 ]. This review demonstrates that the vast majority of studies (observational, in vitro, animal models, and clinical trials) suggest a tangible effect of both topical and injectable platelet preparations on cellular changes, facial esthetics, and wound healing. There are many limitations to the studies included in this review. First, the possibility of a publication bias favoring positive results must be ac- knowledged. Of the 61 studies, few found no observable differences with treatment with a platelet preparation. Se- condly, the results in many of the case series and case control studies were difficult to objectively quantify and remained fairly subjective. It is this inability to convinc- ingly show dramatic results and quantify evidence to sup- port those results that may explain why platelet preparations are not more widely used in plastic surgery. Conclusion

esthetic purposes with a mean follow-up of 9.9 months. Most patients were treated for deep nasolabial folds, while the volume-depleted midface region, superficial rhytids, and acne scars were other commonly treated areas. Patients underwent an average of 1.6 treatments; no patients re- ported any swelling lasting longer than 5 days and most noted only minimal bruising lasting for 1 to 3 days. Most patients were satisfied with the results of their treatments, although 1 patient felt that there was limited or no im- provement after two treatments [ 3 ]. Sclafani injected pla- telet-rich fibrin matrix into the deep dermis and immediate subdermis of the upper arms in human volunteers. Full- thickness skin biopsy specimens over a 10-week period supported the clinical observation of soft tissue augmen- tation. As early as 7 days after treatment, activated fi- broblasts and new collagen deposition were noted and continued to be evident throughout the course of the study. Development of new blood vessels was noted by 19 days; also at this time, intradermal collections of adipocytes and stimulation of subdermal adipocytes were noted. These findings became more pronounced over the duration of the study, although the fibroblastic response became much less pronounced [ 2 ]. Three studies looked specifically at treatment of scars on the face. Gentile et al. looked at ten patients with burn sequelae and post-traumatic scars. They treated patients with autologous fat mixed with PRFM compared to a previously treated ‘‘control’’ group that had received only centrifuged fat. These workers observed a 69 % mainte- nance of contour restoring after 1 year in the PRFM group compared to 39 % in the control [ 51 ]. Lee et al. conducted a split-face trial in 14 Korean participants with acne scars. After ablative CO 2 fractional resurfacing, facial halves were randomly assigned to be treated with autologous P-PRP injections on one side and saline injections on the other side. These authors found treatment with P-PRP after ablative CO 2 fractional resurfacing enhances recovery of laser-damaged skin and synergistically improves the clin- ical appearance of acne scarring [ 52 ]. Gawdat et al. found that intradermal P-PRP injections after fractional ablative CO 2 laser had a significantly better response, fewer side effects, and shorter downtime than laser treatment alone. They also noted that there were no significant differences in intradermal and topical PRP-treated areas in degree of response and downtime [ 53 ]. Na et al. looked specifically at the effect of P-PRP on wound healing following fractional CO 2 laser resurfacing. They treated 25 subjects with fractional CO 2 laser; P-PRP was applied on a randomly allocated side, with saline being used as the contralateral control. These authors found significantly faster recovery of transepidermal water loss, lower erythema index, and melanin index on the P-PRP- treated side. At 28 days, biopsy specimens from the

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