Plasma rico em plaquetas: investigação da efetividade de diferentes protocolos para aplicação em pé diabético

Abstract

Diabetes mellitus (DM) is characterized as a metabolic disorder of persistent hyperglycemia. Diabetic foot is one of the first complications identified in diabetic patients and causes major negative manifestations in their quality of life. These wounds are prone to infection, and when, moderate or severe, they suffer some level of limb amputation. Platelet-rich Plasma (PRP) is a biological product produced from an autologous blood centrifugation process, allowing plasma extraction with a concentration of three to five times higher than that of platelets without basal blood. In this perspective, this study aimed at a systematic review to assess the effectiveness of different PRP recovery protocols for wound treatment and to verify the feasibility of PRP recovery protocols by varying the strength / speed and the centrifugation time. For this purpose, a search was performed in the articles of the Virtual Health Library (VHL) with the descriptors in English and Portuguese “chronic ulcers, Platelet-rich plasma, Deep Soft Tissue Repair, Chronic Wounds, Wound Healing, Regenerative Medicine, Therapeutics and wound healing. Use a combination of descriptors as a search strategy. The publication period was delimited between the years 2010 to 2019. Other productions that were not included in the scientific article category were excluded, such as thesis, dissertations as well as inconclusive work, case reports, review of narrative literature and study on animals. 66 articles were selected, after exclusion, only 13 composite articles or corpus of the study. In 61.5 % of the studies, a PRP autologous gel application was used; and 38.4 % opted for injecting PRP, either subcutaneously or intradermally. Total of 13 studies analyzed, all proven that the PRP assist in the healing and tissue regeneration process. In 23 % of the studies analyzed there was an investigation of the pain variable, with improvements in it and in the patient's quality of life. Clinical trials continue to be of great importance for the case in question, as well as the analysis of systematic literature for recruiting information and increasing the occurrence of subjects. PRP has a great optional therapeutic potential in the treatment and healing process of chronic ulcers. Therefore, the second study aimed to evaluate the effectiveness of the reproduction of two PRP recovery protocols, varying strength / speed and centrifugation time. Twenty trained volunteers were recruited, with platelet count within the reference range 150 - 450.10/³ uL. Two different centrifuges were used to prepare the PRP: 1) CE1161 digital laboratory model centrifuge, adjustable speed - 0 to 5000 rpm with a radius of 14 cm and fixed rotor; with 10 patients; 2) Kasvi digital mod. Ce800, adjustable speed from 100 to 4000 rpm with a radius of 14 cm and variable angle, with 10 patients. The present study found that the preparation of the PRP using the highest force / speed and the centrifugation time, promoting the concentration of coatings statistically higher when compared to the protocol of lower force / speed. It was not possible to reproduce the protocols in different centrifuges. The results pointed out beyond the force of gravity and the centrifugation time, or the rotor angle can also influence the preparation of the PRP.