When scientific research is done on PRP, which is a widely used treatment method in recent years, it is seen that over 15000 scientific articles have been published in good journals. If the journals with low scientific scores are added to this, this number will be well above 20000. So, what is PRP, which is so widely used all over the world, and what are its uses?
When there is any damage to our body and there is a problem with healing, there are methods that we doctors use to accelerate healing from natural sources. Using biological agents is one of these methods.
Biological agents are roughly divided into three.
1-Mesenchymal (precursor) stem cell: Bone marrow and adipose tissue are the main sources of stem cells. The stem cells in the bone marrow are either aspirated and given to the damaged tissue, or the bone marrow cells are tried to be brought directly to the damaged area with the microfracture technique used during the surgery to solve some of the cartilage problems.
Apart from bone marrow, the other source is adipose tissue as I mentioned above. Fat tissue cells taken from the abdomen or around the knee can be used for adipose tissue and the resulting product is given to the damaged area.
As you can see, contrary to popular belief, PRP is not a stem cell, but it is a useful product used in many fields.
The main source of PRP is platelets. Platelets are shaped blood elements formed by precursor cells called megakaryocytes in the bone marrow. When they come out of the damaged vessel, they become activated, settle on the damaged area and form a clot. When platelets are activated, they form branches and spread around the damaged tissue. For this reason, activators are used to accelerate the activation process in some PRP applications.
At this stage, when activated, bioactive proteins, that is, growth factors that contribute to coagulation and tissue healing, are secreted into the environment and thus play a key role in wound healing. They also activate white blood cells and remove dead cells from the tissue.
The most important and roughly functions of these growth factors, which are released from the platelets and are more than 30 in number, are as follows.
Plateletderivedgrowthfactor (PDGF) – Accelerates cell differentiation and revascularization. It stimulates protein synthesis, collagen and matrix production in bone.
Vascularendothelialgrowth factor (VEGF) – accelerates revascularization
Transforminggrowth factor β group (TGF-β)– Approximately 303 factors are in this group. It plays a key role in fibrosis and muscle and bone cell balance. Fibroblastgrowth factor (FGF) – Stimulant for muscle cell proliferation
Epidermalgrowth factor (EGF) – Increases epithelial and mesenchymal cells
Hepatocyte growth factor (HGF) – Accelerates revascularization
Insulin-like growth factor (IGF) – Stimulates muscle and repair cell.
Since it already exists in the body, what is the purpose of using PRP?
Platelets, which are normally between 150 and 400000 ml in the blood, are given to the damaged area much more intensely than in the blood in the treatment with PRP. In other words, the aim is to put functional wound healers more intensely on the target area and to try to increase the natural wound healing ability.
There is no evidence on the exact number of platelets in the prepared fluid. The target is to capture 1 million platelets in 1 ml.
There are many PRP-related products and uses on the market. Among them
-The amount of blood taken
-Feature of the tube from which blood is taken
-Number of centrifuges
– used anticoagulant agent
– Presence of leukocytes in the preparation
There are many differences regarding the use of activators. In fact, the common goal in all of them is to obtain dense thrombocyte, as stated before.
Due to these differences, the need for classification arose and PRP-containing fluids were roughly divided into 4 according to the presence of another blood cell called leukocytes.
1-Pure plateletrich plasma (P-PRP): In other words, those containing only thrombocyte without leukocytes. Example: Vivostat PRF, AnituaPRGF, Nahita, Arthrex PRGF.
2-Leukocyte and plateletrich plasma (L-PRP) containing both leukocytes and platelets. Example: Curasan, Regen, Plateltex, SmartPRP, PCCS, Magellan, GPS III.
3) Pureplateletrich fibrin (P-PRF) or leukocyte-poor plateletrich fibrin
PRP with different product shape but without leukocytes. Example: fibrinet
4) Leukocyte and plateletrich fibrin (L-PRF) PRP with different product shape and containing leukocytes. Example: Choukroun PRF
The content of leukocyte in the product is a subject of disagreement among users. While some authors suggest that leukocyte should be present, some authors do not. There are publications that include the presence of leukocytes in some tendon problems, accelerating the recovery.
PRP is also frequently used in dentistry, maxillofacial surgery, plastic surgery, orthopedics, sports medicine, dermatology and cardiothoracic surgery. It can even be used for cosmetic purposes.
The main areas of use in orthopedics are tendon, muscle and cartilage problems, fracture healing, ligament injuries, shoulder problems and superficial wound problems.
Advantages of PRP:
-Easy to produce
-Does not cause allergic reaction
-It is reliable.
-There may be pain during the injection (especially those containing leukocytes)
-Inflammatory reaction may be seen.
-Local irritation may be seen
Although it is not stated as a definite contraindication, it is not recommended in cancer patients and pregnancy, although there are no serious side effects.
In patients with thrombocyte and coagulation disorders, although it is not harmful, it is more likely not to be beneficial because it is a purely platelet-derived product. Aspirin users should stop using aspirin at least 5 days before.
No drug or product, including PRP, provides a hundred percent guaranteed cure. But in general, it is a product with a high percentage of satisfaction.