title: Treatment of chronic non-healing ulcers using autologous platelet rich plasma: a case series.
abstract: BACKGROUND
  Non-healing ulcers are a major health problem worldwide and have great impact at personal, professional and social levels, with high cost in terms of human and material resources. Recalcitrant non-healing ulcers are inevitable and detrimental to the lower limb and are a major cause of non-traumatic lower limb amputations. Application of autologous Platelet Rich Plasma (PRP) has been a major breakthrough for the treatment of non-healing and diabetic foot ulcers, as it is an easy and cost-effective method, and provides the necessary growth factors that enhance tissue healing. PRP is a conglomeration of thrombocytes, cytokines and various growth factors which are secreted by α-granules of platelets that augment the rate of natural healing process with decrease in time. The purpose of this case series was to evaluate the safety and efficacy of autologous platelet rich plasma for the treatment of chronic non-healing ulcers on the lower extremity.
  
  
  METHODS
  Autologous PRP was prepared from whole blood utilizing a rapid, intraoperative point-of-care system that works on the principle of density gradient centrifugation. Twenty Four (24) patients with non-healing ulcers of different etiologies, who met the inclusion criteria, were treated with single dose of subcutaneous PRP injections along with topical application of PRP gel under compassionate use.
  
  
  RESULTS
  The mean age of the treated patients was 62.5 ± 13.53 years and they were followed-up for a period of 24 weeks. All the patients showed signs of wound healing with reduction in wound size, and the mean time duration to ulcer healing was 8.2 weeks. Also, an average five fold increase in the platelet concentrate was observed in the final PRP product obtained using the rapid point-of-care device, and the average platelet dose administered to the patients was 70.10 × 108.
  
  
  CONCLUSIONS
  This case series has demonstrated the potential safety and efficacy of autologous platelet rich plasma for the treatment of chronic non-healing ulcers.
  
  
  BACKGROUND
  NCT03026855 , Registered 4 January 2017 'Retrospectively'.
authors.affiliation: TotipotentRX Center for Cellular Medicine (Cesca Therapeutics Inc., USA), Fortis Memorial Research Institute, Gurgaon-122002, Delhi, (NCR), India.
authors.forename: Manish
authors.initials: M
authors.lastname: Suthar
authors.affiliation: TotipotentRX Center for Cellular Medicine (Cesca Therapeutics Inc., USA), Fortis Memorial Research Institute, Gurgaon-122002, Delhi, (NCR), India.
authors.forename: Saniya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Fortis Escorts Heart Institute and Research Center, New Delhi, India.
authors.forename: Suhail
authors.initials: S
authors.lastname: Bukhari
authors.affiliation: TotipotentRX Center for Cellular Medicine (Cesca Therapeutics Inc., USA), Fortis Memorial Research Institute, Gurgaon-122002, Delhi, (NCR), India. vponemone@cescatherapeutics.com.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Ponemone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion; D001804:Blood Transfusion, Autologous; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053657:Platelet-Rich Plasma; D014456:Ulcer / Q000097:blood / Q000628:therapy*
keywords: Autologous platelet rich plasma; Cellular therapy; Cytokines; Growth factors; Non-healing ulcers; Point-of-care