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Platelet-rich plasma (PRP), the first practical application of tissue engineering, has produced a respectable database of research findings and clinical outcomes in a variety of settings. A concentrated source of autologous platelets, PRP contains and releases (through degranulation) at least seven different growth factors (cytokines) that stimulate bone and soft tissue healing. The separation and concentration of the platelets is an exact science. Extreme care must be taken when blood products are harvested and processed. In addition to well-known concerns of HIV transfer, other concerns exist. Because of factors involving its availability and cost, platelet-rich plasma (PRP) has become an increasingly popular clinical tool as an alternative source of growth factors for several types of medical treatments, including wound healing in surgery, tendonitis, cardiac care, cartilage regeneration, disc regeneration, and dental health. The clinical applications of PRP in dentistry, for example, include cosmetic periodontal surgery, aesthetic dental implant reconstruction, and the immediate restoration of dental implants. Pioneer use of PRP in dentistry includes the work of Dr. Arun K. Garg and Dr. Robert Marx. Most recently, PRP has found popular and effective applications in sports medicine (including mending injured tendons and ligaments in joints without surgery). Dr. Allan Mishra published the first article supporting the use of Platelet Rich Plasma for tendonitis and sports medicine applications. He has subsequently published several other articles supporting the use of PRP in connective tissue.

Not all PRP is the same. The strict definition of PRP is platelet concentration above baseline (published by Marx). PRP may or may not also contain increased concentrations of white blood cells. The data supporting the use of PRP for tendonitis contains 5.5x baseline and a similar increase in white blood cells. As more data emerges from clinical trials, the dosage of PRP must be better defined.

Specific Uses

Essential for understanding the biologic rationale of PRP is understanding the role of platelets in wound healing as well as the clinical effect of PRP in bone regeneration and soft tissue healing. PRP stimulates an earlier and more complete revascularization derived from the connective tissue base, which develops a nutrient gradient into which epithelial cells can migrate. For skin repair after wounds or surgery, such early epithelial coverings of exposed granulation tissue and connective tissue and the development of dermis are thought to be the mechanism that reduces scarring and provides a maximum regeneration of normal skin pigmentation. For bone repair, platelet-rich plasma (PRP) can be added to harvested autogenous bone or to a mixture of autogenous bone and freeze-dried bone/alloplastic material to improve the consistency for handling during surgery and minimizing particulate migration as well as to add increased platelets (i.e. increased growth factors) into the area. In cases involving surgery-free repair of joints, tendons, and ligaments, blood taken from the patient is processed into PRP and then injected into the injured area to accelerate healing.

See also

blood plasma
platelets
thrombocytes
bone grafting
dental implant
platelet swirling

References

  • Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (March 2009). "Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)". Trends in Biotechnology 27 (3): 158–67. doi:10.1016/j.tibtech.2008.11.009. PMID 19187989.  
  • Aimetti M, Romano F, Dellavia C, De Paoli S (December 2008). "Sinus grafting using autogenous bone and platelet-rich plasma: histologic outcomes in humans". The International Journal of Periodontics & Restorative Dentistry 28 (6): 585–91. PMID 19146054.  
  • Maniscalco P, Gambera D, Lunati A, et al. (December 2008). "The "Cascade" membrane: a new PRP device for tendon ruptures. Description and case report on rotator cuff tendon". Acta Bio-medica 79 (3): 223–6. PMID 19260383.  
  • Por YC, Shi L, Samuel M, Song C, Yeow VK (May 2009). "Use of tissue sealants in face-lifts: a metaanalysis". Aesthetic Plastic Surgery 33 (3): 336–9. doi:10.1007/s00266-008-9280-1. PMID 19089492.  
  • Griffin XL, Smith CM, Costa ML (February 2009). "The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review". Injury 40 (2): 158–62. doi:10.1016/j.injury.2008.06.025. PMID 19084836.  
  • Gonshor A (December 2002). "Technique for producing platelet-rich plasma and platelet concentrate: background and process". The International Journal of Periodontics & Restorative Dentistry 22 (6): 547–57. PMID 12516826.  
  • Weibrich G, Kleis WK, Hafner G, Hitzler WE, Wagner W (June 2003). "Comparison of platelet, leukocyte, and growth factor levels in point-of-care platelet-enriched plasma, prepared using a modified Curasan kit, with preparations received from a local blood bank". Clinical Oral Implants Research 14 (3): 357–62. doi:10.1034/j.1600-0501.2003.00810.x. PMID 12755786.  
  • Marx RE, Garg AK (1999). "Bone Graft Physiology with Use of Platelet-Rich Plasma and Hyperbaric Oxygen". in Jensen OT. The Sinus Bone Graft. Chicago: Quintessence. pp. 183–189. ISBN 0-86715-343-1.  
  • Mishra A, Pavelko T (November 2006). "Treatment of chronic elbow tendinosis with buffered platelet-rich plasma". The American Journal of Sports Medicine 34 (11): 1774–8. doi:10.1177/0363546506288850. PMID 16735582.  
  • Mishra A, Woodall J, Vieira A (January 2009). "Treatment of tendon and muscle using platelet-rich plasma". Clinics in Sports Medicine 28 (1): 113–25. doi:10.1016/j.csm.2008.08.007. PMID 19064169.  
  • Mishra A, Tummala P, King A, et al. (February 2009). "Buffered Platelet-Rich Plasma Enhances Mesenchymal Stem Cell Proliferation and Chondrogenic Differentiation". Tissue Engineering. Part C, Methods: 090213063338039. doi:10.1089/ten.tec.2008.0534. PMID 19216642.  
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