platelet rich plasma ( PRP ) is a platelet-rich plasma protein concentrate derived from intact blood, centrifuged to remove red blood cells. It has a greater concentration of growth factors than whole blood, and has been used to promote rapid healing responses in several specialties, particularly plastic surgery, dentistry, orthopedics, and dermatology.
As a concentrated source of plasma plasma and autologous conditioned plasma, PRP contains several different growth factors and other cytokines that can stimulate healing of soft tissues and joints. There are many indications such as in sports medicine and orthopedics (acute muscle strains, tendinopathy and muscle-fascist injury and osteoarthritis), or dermatology (androgenic alopecia, wound healing, and skin rejuvenation) or even in proctology (fistula-in-ano). For PRP preparation, various protocols are used, with the principle underlying platelet concentrations being 3-5 times the physiological level, then injecting these concentrates into tissues where healing is desirable.
Video Platelet-rich plasma
Medical use
In humans, PRP has been studied and used as a clinical tool for several types of medical treatment, including chronic tendinitis, osteoarthritis, for bone repair and regeneration, in oral surgery, and in plastic surgery, for example using a platelet-rich fibrin method.
Clinical validity
A 2015 meta-analysis reviewed 551 studies on PRP for osteoarthritic (OA) knee and found that only nine were worth considering and concluded that with regard to short-term outcomes, PRP was no more efficacious than placebo in the total WOMAC score but more efficacious than hyaluronic acid HA) at that size; it is no different from placebo or HA due to side effects.
In 2016 the results of basic science and preclinical testing have not been confirmed in large-scale randomized controlled trials. A systematic review of scientific literature in 2009 found that there were several randomized controlled trials that adequately evaluated the safety and efficacy of PRP treatment and concluded that PRP was a "promising but unproven treatment option for joints, tendons, ligaments, and muscle injuries.".
A 2010 Cochrane analysis of the use of PRP in sinus removal during dental implant installation found no evidence that PRP offers any benefit.
Cerza 2012 Am Journal Sports Med, level 1, randomized controlled trial concluded that PRP was significantly better for knee OA than hyaluronic acid.
A 2013 review stated more evidence was needed to determine the effectiveness of PRP for hair regrowth.
Cochrane 2014 analysis for the use of domestic workers to treat musculoskeletal injuries finds very weak evidence (very low quality) for short-term pain reduction, up to three months and no functional differences in the short, medium or long term. There is weak evidence to suggest that the damage occurs at a comparable, low level in treated and untreated persons.
In 2014, the American Journal of Sports Medicine published a paper concluding that "the application of 3 PRP injections significantly improves symptoms and function in athletes with chronic patellar tendinopathy and allows rapid recovery and return to exercise. returns to the normal architecture of the tendon as judged by MRI.
A systematic review and meta-analysis 2016 from randomized controlled clinical trials for use of PRP to supplement bone graft found that only one study reported significant differences in bone enlargement, while four studies found no significant difference.
Since 2004, PRP therapy supporters have argued that negative clinical outcomes are associated with poor quality PRP produced by inadequate single spin devices. The fact that most collecting devices capture the percentage of given platelet count can lead to bias, since the variability between individuals in plasma plasma platelet concentrations and more is not always better. Variability in thrombocyte concentration techniques can alter the characteristic of platelet degranulation which may affect clinical outcomes.
In the field of aesthetics and plastic surgery, clinical applications are extensive and on behalf of Regenerative Plastic Surgery. PRP associated with adipose tissue, given for breast reconstruction, facial soft tissue defects, lower limb ulcers, and scars. Promising results are obtained in the treatment of androgenetic alopecia, as it emerges from scientific studies published since 2013. Among these, the most significant by impact factors are clinical-clinical studies of randomized clinical-instrumental evaluation of PRP effects in androgenetic alopecia published in 2015 by Pietro Gentile et al. and a multidisciplinary team at the Rome University of Tor Vergata The Effects of Platelet Rich Plasma in Hair Growth: Random Placebo Trial. .
Maps Platelet-rich plasma
Adverse effects
No studies to date have documented the adverse effects associated with PRP treatment, probably because of poor and inconsistent methodologies.
Composition
There are four general categories of PRP preparation based on the content of leukocytes and fibrin: leukocyte-rich PRP (L-PRP), leukocytes reduce PRP (p-PRP, reduced leukocytes or pure PRP), platelet leaf-rich fibrin and pure platelets-fibrin rich.
The efficacy of certain growth factors in the healing of various injuries and growth factor concentrations found in PRP is the theoretical basis for the use of PRP in tissue repair. Platelets collected in PRP are activated by the addition of thrombin and calcium chloride, which induce the release of the mentioned factors of alpha granules. Other growth factors and cytokines present in PRP include:
- growth factor derived from platelets
- change the beta growth factor
- fibroblast growth factor
- growth factors such as insulin 1
- growth factors like insulin 2
- vascular endothelial growth factor
- epidermal growth factor
- Interleukin 8
- keratinocyte growth factor
- connective tissue growth factor
Manufacturing
In 2009, there were two PRP preparation methods approved by the US Food and Drug Administration. Both processes involve the collection of all patients' blood (given anticoagulants with citrate dextrose) before undergoing two centrifugation steps (TruPRP) (PURE) (PRP Pure) designed to separate the PRP aliquots from poor platelet plasma and red blood cells. In humans, the baseline number of typical blood platelets is about 200,000 per Ã,ÂμL; Therapeutic PRP concentrates platelets about fivefold. There is wide variability in the production of PRP by various concentrating tools and techniques.
History
PRP was first developed in 1970 and was first used in Italy in 1987 in open heart surgery procedures. PRP therapy began to gain popularity in the mid-1990s. Since then it has been applied to various medical fields such as cosmetic surgery, dentistry, sports medicine and pain management.
The number of peer reviewed publications studying the effectiveness of PRP has increased dramatically since 2007.
Society and culture
The cost of PRP treatment in the US has been cited as $ 1000 outpouring of bags, as it is not normally covered by health insurance.
PRP has received attention in popular media as a result of its use in treating sports injuries to professional athletes.
Risk of use in doping
Some concerns exist, whether PRP treatment violates anti-doping rules. In 2010 it was not clear whether local PRP injection could have systemic effects on circulating cytokine levels, affecting doping tests and whether PRP treatment had systemic anabolic effects or affected performance. In January 2011, the World Anti-Doping Agency removed the intramuscular injection of PRP from its prohibition after determining that there was "a lack of current evidence regarding the use of this method for performance improvement purposes".
According to Baltimore Sun, Zach Britton has a PRP injection on his left shoulder in March 2012, Orioles first baseman Chris Davis underwent two PRP injections to speed healing and recovery of an oblique injury in April 2014, and Dylan Bundy underwent a procedure in April. before undergoing Tommy John's surgery in June 2014.
Veterinary use
Platelet-rich plasma is used on horses for the treatment of horse tilt due to tendons and ligament injuries, wounds, fractures, bone cysts, and osteoarthritis.
See also
- autologous blood injection
- Pre-conditional plasma hypoxia
- Ortokin
References
Source of the article : Wikipedia
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