title: Infected Nonhealing Wound in a Kidney Transplant Recipient: Successful Treatment With Topical Homologous Platelet-Rich Gel.
abstract: Impaired would healing is a known adverse effect of chronic immunosuppression. Solid-organ transplant recipients undergoing major abdominal surgery have an increased risk of wound-related complications compared with the general population. In this subset of patients, surgical site infections and wound dehiscence must be aggressively treated to avoid sepsis, graft loss, and death. Recently, topical application of platelet-rich plasma has been proposed as an alternative therapeutic option to enhance wound healing in difficult cases. Unfortunately, randomized controlled trials evaluating the efficacy of platelet-rich plasma compared with standard or advanced wound management are lacking, and the literature mostly refers to anecdotal reports in patients with no evidence of wound infection. This report documents a kidney transplant recipient who experienced spontaneous bladder rupture because of gangrenous cystitis. After an exploratory laparotomy and bladder repair, the patient developed a deep surgical site infection by multidrug resistant Acinetobacter baumannii and extensive wound dehiscence. Advanced wound management and vacuum-assisted closure therapy were ineffective. Topical homologous platelet-rich gel was used resulting in significant wound healing, without infections or immunologic complications.
authors.affiliation: >From the Organ Transplantation, Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Iesari
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Anna
authors.initials: A
authors.lastname: Rughetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Dell'Orso
authors.forename: Katia
authors.initials: K
authors.lastname: Clemente
authors.forename: Antonio
authors.initials: A
authors.lastname: Famulari
authors.forename: Francesco
authors.initials: F
authors.lastname: Pisani
authors.forename: Evaldo
authors.initials: E
authors.lastname: Favi
mesh_terms: D000151:Acinetobacter Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000601:surgery*; D040981:Acinetobacter baumannii / Q000276:immunology / Q000302:isolation & purification*; D003556:Cystitis / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000601:surgery*; D005782:Gels; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D053657:Platelet-Rich Plasma; D012422:Rupture, Spontaneous; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D005782:Gels; D007166:Immunosuppressive Agents