title: Prospective Randomized Evaluation of Intraoperative Application of Autologous Platelet-Rich Plasma on Surgical Site Infection or Delayed Wound Healing.
abstract: BACKGROUND
  Prevention of surgical site infections and the reduction of wound-related complication rates have become increasingly emphasized by hospital task groups and government agencies given the degree of economic burden it places on the health care system. Platelet-rich plasma (PRP) contains growth factors and other biomolecules that promote endogenous microbicidal activity. We hypothesized that PRP would help prevent postoperative infection and delayed wound healing (DWH).
  
  
  METHODS
  We randomized patients having foot or ankle surgery to the treatment group receiving intraoperative PRP (applied to operative field) and platelet-poor plasma at closing (PPP, on the sutured skin) or the control group (no PRP/PPP). The incidence of deep surgical site infection and DWH (collectively called endpoints) was compared between groups (n = 250/group). PRP had a mean 5.3-fold platelet concentration compared to whole blood, with concentrated white blood cells. Mean age (±SD) of patients was 52 years (±15), 65% were women. Minor and major operative procedures were included. Patients were followed for 60 days. Seventy controls had PRP prepared for assay of growth factors. Procedure mix, ASA scores, mean operative times, and comorbidity mix were similar between groups.
  
  
  RESULTS
  The primary result was no difference in number of endpoints between groups: 19 patients in the PRP group (7.6%) versus 18 controls (7.2%). Endpoints were deep surgical site infections in 2 PRP/PPP patients and 1 control, and DWH in 17 PRP/PPP patients and 17 controls. Analysis of PRP samples revealed a large variation in growth factor concentrations between patients.
  
  
  CONCLUSIONS
  Intraoperative application of PRP/PPP did not reduce the incidence of postoperative infection or DWH. Growth factor profiles varied greatly between patients, suggesting that the potentially therapeutic treatment delivered was not consistent from patient-to-patient.
  
  
  METHODS
  Level I, prospective randomized trial.
authors.affiliation: Miami Orthopedics and Sports Medicine Institute (founded by UHZ Sports Medicine), Coral Gables, FL, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: SanGiovanni
authors.affiliation: Miami Orthopedics and Sports Medicine Institute (founded by UHZ Sports Medicine), Coral Gables, FL, USA garykiebzak@sbcglobal.net.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Kiebzak
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D015994:Incidence; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010949:Plasma; D053657:Platelet-Rich Plasma; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D017211:Treatment Failure; D014945:Wound Healing / Q000502:physiology
chemical_list: D036341:Intercellular Signaling Peptides and Proteins
keywords: delayed wound healing; platelet-rich plasma; postoperative infection