title: Biological approach for the management of non-healing diabetic foot ulcers.
abstract: OBJECTIVE
  To show an approach to profit of the main components of platelet rich plasma (PRP), i.e. the signaling proteins, and the fibrin scaffold and discuss the intervention within TIME (Tissue, Inflammation/Infection, Moisture, Edges) framework.
  
  
  METHODS
  Two patients with diabetic foot ulcers are treated with both liquid and gelled PRP, and the rationale for the PRP intervention is described herein. Autologous blood is withdrawn and, PRP is separated by single spinning and activated with CaCl2 prior to application. PRP is injected in an activated liquid form, i.e. freshly activated, before coagulation, within the wound edges. In fibrotic tissue PRP is introduced performing a needling procedure. In addition, PRP, clotted ex-vivo, is applied in the wound bed as a primary dressing.
  
  
  RESULTS
  Both patients responded positively to PRP intervention. Case 1 healed after five weekly PRP applications. Case 2 healed after eight weekly PRP applications. Patient satisfaction was high in both cases. The procedure had no complications, is well tolerated and easy to perform in any medical setting.
  
  
  CONCLUSIONS
  PRP intervention is safe and if associated with correct tissue debridement and preparation of the host tissue it may help to decrease the burden of diabetic foot ulcers. Carefully designed randomized clinical trials with special attention to the PRP procedure are needed to assess the efficacy of these interventions.
authors.affiliation: Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Mariaelena.perezzabala@osakidetza.eus.
authors.forename: Elena
authors.initials: E
authors.lastname: Perez-Zabala
authors.affiliation: Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Andima.basterretxeaozamiz@osakidetza.eus.
authors.forename: Andima
authors.initials: A
authors.lastname: Basterretxea
authors.affiliation: Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Ainara.larrazabalarbaiza@osakidetza.eus.
authors.forename: Ainara
authors.initials: A
authors.lastname: Larrazabal
authors.affiliation: Hospital-at-Home Department, Cruces University Hospital, OSI, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Karmele.perezdelpecho@osakidetza.eus.
authors.forename: Karmele
authors.initials: K
authors.lastname: Perez-Del-Pecho
authors.affiliation: BioCruces Health Research Institute, Cruces University Hospital, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: Eva.rubioazpeitia@osakidetza.eus.
authors.forename: Eva
authors.initials: E
authors.lastname: Rubio-Azpeitia
authors.affiliation: BioCruces Health Research Institute, Cruces University Hospital, Pza Cruces S/N, 48903 Barakaldo, Spain. Electronic address: iandia2010@hotmail.com.
authors.forename: Isabel
authors.initials: I
authors.lastname: Andia
mesh_terms: D017719:Diabetic Foot / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053657:Platelet-Rich Plasma; D016896:Treatment Outcome
keywords: Cytokines; Diabetic foot ulcer; Fibrosis; Growth factors; Platelet rich plasma