What Is the Main Idea?

“Platelet-Rich Plasma in Plastic Surgery: A Systematic Review” is a systematic literature review published in the journal Transfusion Medicine and Hemotherapy. The authors (S.K. Hasiba-Pappas and co-workers) reviewed 50 studies that looked at the use of platelet-rich plasma as an aid to healing in various types of plastic surgery and summarized their findings. This post looks at those findings along with other information about platelet-rich plasma.

What Else Can You Learn?

This blog post describes what platelet-rich plasma is, how it is used, and what it can be used for, along with some of the side effects and controversies around its use.

What Is Platelet-Rich Plasma?

Platelet-rich plasma (PRP) is blood taken from a patient and centrifuged (spun very rapidly), which separates the components of the blood and concentrates the platelets within the plasma. This plasma is then re-injected into the patient. This concentrated sample is intended to accelerate healing, particularly of muscles, tendons, ligaments, and joints. The theory is that the higher concentrations of growth factors, cytokines, etc. will stimulate tissue regeneration. There is also some evidence that it could be used in osteoarthritis as a means to reduce inflammation and in bone grafting and lipofilling procedures to increase graft survival. Theoretically, it could be used for treating chronic wounds, burn injuries, and even scars.

Why Is It Important to Have a Literature Review of PRP Use in Plastic Surgery?

The authors of “Platelet-Rich Plasma in Plastic Surgery: A Systematic Review” aimed to collect all the information about PRP use in plastic surgery in one place. This will help advance research into treatments based on this approach. The papers they reviewed included procedures for reconstruction or wound treatment; cosmetic treatment; hand surgery; burn injuries; craniofacial disorders; and fat grafting.

Why Is Platelet-Rich Plasma Use Controversial?

This approach has gained considerable attention in clinical settings because of the potential for accelerating tissue regeneration. However, there is a lack of consistent data on the results of procedures using PRP and the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have not yet approved it fully. For example, the FDA allows it as an “off-label” treatment for certain muscular and skeletal conditions as well as some plastic surgery.

Part of the issue with PRP is the lack of a standardized protocol for its preparation. One of the aims of the authors of “Platelet-Rich Plasma in Plastic Surgery: A Systematic Review” was to look at the differences in preparation methods. They noted that some studies used double-spin centrifugation while others used a single-spin protocol. Some activated the platelets in the PRP, some didn’t. The number of treatments varied as well. This type of variation will always cause controversy when something is considered for medical applications.

Does Platelet-Rich Plasma Treatment Have Side Effects?

The main side effect (or adverse effect) of PRP treatment is pain. Patients report pain at the site of injection and in the joint, muscle, or general area that is injured or damaged. This pain is to be expected though: Platelet-related healing involves an inflammatory response. Platelets release chemicals in the injured area to ensure that other healing factors move to and activate in that area. In addition, as noted in “Platelet-Rich Plasma in Plastic Surgery: A Systematic Review”, hematomas can occur. These are localized bleeding outside of the blood vessels, similar to a bruise. However, hematomas need more careful observation as they can lead to a critical drop in blood pressure. Yet, most patients did not experience any adverse effects and all the authors of the studies reviewed by S.K. Hasiba-Pappas and co-workers concluded that PRP is safe for therapeutic use.

What Were the Results for Plastic Surgery?

Based on the papers reviewed, PRP use showed:

  • Significantly better results in skin grafting, including for skin grafts on burns, and wound treatment
  • Inconclusive results in scar treatment, breast reconstruction, managing hair loss, and face lifts
  • Promising results in hand surgery
  • Varied results in fat grafting

The authors conclude that PRP is becoming increasingly widely used in plastic surgery, with a good number of trials on the benefits in reconstructive and aesthetic surgery. Several beneficial effects have been identified, but the variations in preparation methods, treatment protocols, and outcomes are still holding this method back from widespread use. Unfortunately, further prospective randomized controlled studies are needed, and standardized protocols will be essential.

Should You Ask Your Plastic Surgeon about PRP?

If you are having plastic surgery, particularly skin grafts and wound treatment, but also hand surgery, there’s certainly enough evidence to support talking to your plastic surgeon about the possibility of using PRP to accelerate or improve healing. However, it may be counterindicated by other factors (e.g., the presence of metastatic diseases, active infections, or low platelet counts) or your plastic surgeon may not have the equipment for it. In the future, it’s very likely to become a more common procedure, based on current evidence.

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