Histological analysis of fat grafting with platelet‐rich plasma for diabetic foot ulcers—A randomised controlled trial
Diabetic foot ulcers are often unresponsive to conventional therapy and are a leading cause of amputation. Animal studies have shown stem cells and growth factors can accelerate wound healing. Adipose‐derived stem cells are found in fat grafts and mixing them with platelet‐rich plasma (PRP) may impr...
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| Veröffentlicht in: | International wound journal 2022-02, Vol.19 (2), p.389-398 |
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| creator | Nolan, Grant Switzer Smith, Oliver John Heavey, Susan Jell, Gavin Mosahebi, Afshin |
| description | Diabetic foot ulcers are often unresponsive to conventional therapy and are a leading cause of amputation. Animal studies have shown stem cells and growth factors can accelerate wound healing. Adipose‐derived stem cells are found in fat grafts and mixing them with platelet‐rich plasma (PRP) may improve graft survival. This study aimed to establish the histological changes when diabetic foot ulcers are treated with fat grafts and PRP. A three‐armed RCT was undertaken of 18 diabetic foot ulcer patients: fat grafting; fat grafting with PRP; and routine podiatry care. Biopsies were obtained at week 0, 1, and 4, and underwent quantitative histology/immunohistochemistry (H&E, CD31, and Ki67). Treatment with fat and PRP increased mean microvessel density at 1 week to 1645 (SD 96) microvessels/mm2 (+32%‐45% to other arms, P = .035). PRP appeared to increase vascularity surrounding fat grafts, and histology suggested PRP may enhance fat graft survival. There was no clinical difference between arms. This study demonstrates PRP with fat grafts increased neovascularisation and graft survival in diabetic foot ulcers. The histology was not, however, correlated with wound healing time. Future studies should consider using apoptosis markers and fluorescent labelling to ascertain if enhanced fat graft survival is due to proliferation or reduced apoptosis. Trial registration NCT03085550. |
| doi_str_mv | 10.1111/iwj.13640 |
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Animal studies have shown stem cells and growth factors can accelerate wound healing. Adipose‐derived stem cells are found in fat grafts and mixing them with platelet‐rich plasma (PRP) may improve graft survival. This study aimed to establish the histological changes when diabetic foot ulcers are treated with fat grafts and PRP. A three‐armed RCT was undertaken of 18 diabetic foot ulcer patients: fat grafting; fat grafting with PRP; and routine podiatry care. Biopsies were obtained at week 0, 1, and 4, and underwent quantitative histology/immunohistochemistry (H&E, CD31, and Ki67). Treatment with fat and PRP increased mean microvessel density at 1 week to 1645 (SD 96) microvessels/mm2 (+32%‐45% to other arms, P = .035). PRP appeared to increase vascularity surrounding fat grafts, and histology suggested PRP may enhance fat graft survival. There was no clinical difference between arms. This study demonstrates PRP with fat grafts increased neovascularisation and graft survival in diabetic foot ulcers. The histology was not, however, correlated with wound healing time. Future studies should consider using apoptosis markers and fluorescent labelling to ascertain if enhanced fat graft survival is due to proliferation or reduced apoptosis. Trial registration NCT03085550.</description><identifier>ISSN: 1742-4801</identifier><identifier>EISSN: 1742-481X</identifier><identifier>DOI: 10.1111/iwj.13640</identifier><identifier>PMID: 34169656</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adipocytes ; Adipose Tissue ; adipose‐derived stem cells ; Angiogenesis ; Animals ; Biopsy ; Cell growth ; Diabetes ; Diabetes Mellitus ; Diabetic Foot - surgery ; diabetic foot ulcers ; fat grafting ; Foot diseases ; Growth factors ; histology ; Humans ; Leg ulcers ; Original ; Platelet-Rich Plasma ; Statistical analysis ; Stem Cells ; Systematic review ; Variance analysis ; Wound Healing</subject><ispartof>International wound journal, 2022-02, Vol.19 (2), p.389-398</ispartof><rights>2021 The Authors. published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.</rights><rights>2021 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.</rights><rights>2022. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the "License"). 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Animal studies have shown stem cells and growth factors can accelerate wound healing. Adipose‐derived stem cells are found in fat grafts and mixing them with platelet‐rich plasma (PRP) may improve graft survival. This study aimed to establish the histological changes when diabetic foot ulcers are treated with fat grafts and PRP. A three‐armed RCT was undertaken of 18 diabetic foot ulcer patients: fat grafting; fat grafting with PRP; and routine podiatry care. Biopsies were obtained at week 0, 1, and 4, and underwent quantitative histology/immunohistochemistry (H&E, CD31, and Ki67). Treatment with fat and PRP increased mean microvessel density at 1 week to 1645 (SD 96) microvessels/mm2 (+32%‐45% to other arms, P = .035). PRP appeared to increase vascularity surrounding fat grafts, and histology suggested PRP may enhance fat graft survival. There was no clinical difference between arms. This study demonstrates PRP with fat grafts increased neovascularisation and graft survival in diabetic foot ulcers. The histology was not, however, correlated with wound healing time. Future studies should consider using apoptosis markers and fluorescent labelling to ascertain if enhanced fat graft survival is due to proliferation or reduced apoptosis. Trial registration NCT03085550.</description><subject>Adipocytes</subject><subject>Adipose Tissue</subject><subject>adipose‐derived stem cells</subject><subject>Angiogenesis</subject><subject>Animals</subject><subject>Biopsy</subject><subject>Cell growth</subject><subject>Diabetes</subject><subject>Diabetes Mellitus</subject><subject>Diabetic Foot - surgery</subject><subject>diabetic foot ulcers</subject><subject>fat grafting</subject><subject>Foot diseases</subject><subject>Growth factors</subject><subject>histology</subject><subject>Humans</subject><subject>Leg ulcers</subject><subject>Original</subject><subject>Platelet-Rich Plasma</subject><subject>Statistical analysis</subject><subject>Stem Cells</subject><subject>Systematic review</subject><subject>Variance analysis</subject><subject>Wound Healing</subject><issn>1742-4801</issn><issn>1742-481X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc9qVDEUxi9isbW68AUk4EYX0yY3_-7dCKVU21Jwo-gu5CYn0wyZmzHJdZiu-ggufMI-ibFTBxXMJudwfnx853xN84LgI1LfsV8vjggVDD9qDohk7Yx15MvjXY3JfvM05wXGbc-5fNLsU0ZEL7g4aG7OfS4xxLk3OiA96rDJPqPokNMFzZN2xY9ztPblGq2CLhCg3N1-T97c93mpkYsJWa8HKN7UJhY0BQMp393-OEFJjzYufQaLTBxLiiHUsiSvw7Nmz-mQ4fnDf9h8enf28fR8dvXh_cXpydXMMEbxzFpLpJXSdl2LNRfgLKWE9NQKZzHR0GojoafcDJj1MDBLOjlA64BxxmCgh83bre5qGpZgDVQbOqhV8kudNipqr_6ejP5azeM31UnRcoarwOsHgRS_TpCLqgsZCEGPEKesKsR5TyUWFX31D7qIU6pXzYriHgvc8Z5V6s2WMinmnMDtzBCsfiWqaqLqPtHKvvzT_Y78HWEFjrfA2gfY_F9JXXy-3Er-BC5xsCQ</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Nolan, Grant Switzer</creator><creator>Smith, Oliver John</creator><creator>Heavey, Susan</creator><creator>Jell, Gavin</creator><creator>Mosahebi, Afshin</creator><general>Blackwell Publishing Ltd</general><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0220-3218</orcidid></search><sort><creationdate>202202</creationdate><title>Histological analysis of fat grafting with platelet‐rich plasma for diabetic foot ulcers—A randomised controlled trial</title><author>Nolan, Grant Switzer ; Smith, Oliver John ; Heavey, Susan ; Jell, Gavin ; Mosahebi, Afshin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4430-ddd17d77d8820a56efd331193d6fd01ae2ac7e935cb049eb4d187be2fe4544eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adipocytes</topic><topic>Adipose Tissue</topic><topic>adipose‐derived stem cells</topic><topic>Angiogenesis</topic><topic>Animals</topic><topic>Biopsy</topic><topic>Cell growth</topic><topic>Diabetes</topic><topic>Diabetes Mellitus</topic><topic>Diabetic Foot - surgery</topic><topic>diabetic foot ulcers</topic><topic>fat grafting</topic><topic>Foot diseases</topic><topic>Growth factors</topic><topic>histology</topic><topic>Humans</topic><topic>Leg ulcers</topic><topic>Original</topic><topic>Platelet-Rich Plasma</topic><topic>Statistical analysis</topic><topic>Stem Cells</topic><topic>Systematic review</topic><topic>Variance analysis</topic><topic>Wound Healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nolan, Grant Switzer</creatorcontrib><creatorcontrib>Smith, Oliver John</creatorcontrib><creatorcontrib>Heavey, Susan</creatorcontrib><creatorcontrib>Jell, Gavin</creatorcontrib><creatorcontrib>Mosahebi, Afshin</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International wound journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nolan, Grant Switzer</au><au>Smith, Oliver John</au><au>Heavey, Susan</au><au>Jell, Gavin</au><au>Mosahebi, Afshin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Histological analysis of fat grafting with platelet‐rich plasma for diabetic foot ulcers—A randomised controlled trial</atitle><jtitle>International wound journal</jtitle><addtitle>Int Wound J</addtitle><date>2022-02</date><risdate>2022</risdate><volume>19</volume><issue>2</issue><spage>389</spage><epage>398</epage><pages>389-398</pages><issn>1742-4801</issn><eissn>1742-481X</eissn><abstract>Diabetic foot ulcers are often unresponsive to conventional therapy and are a leading cause of amputation. Animal studies have shown stem cells and growth factors can accelerate wound healing. Adipose‐derived stem cells are found in fat grafts and mixing them with platelet‐rich plasma (PRP) may improve graft survival. This study aimed to establish the histological changes when diabetic foot ulcers are treated with fat grafts and PRP. A three‐armed RCT was undertaken of 18 diabetic foot ulcer patients: fat grafting; fat grafting with PRP; and routine podiatry care. Biopsies were obtained at week 0, 1, and 4, and underwent quantitative histology/immunohistochemistry (H&E, CD31, and Ki67). Treatment with fat and PRP increased mean microvessel density at 1 week to 1645 (SD 96) microvessels/mm2 (+32%‐45% to other arms, P = .035). PRP appeared to increase vascularity surrounding fat grafts, and histology suggested PRP may enhance fat graft survival. There was no clinical difference between arms. This study demonstrates PRP with fat grafts increased neovascularisation and graft survival in diabetic foot ulcers. The histology was not, however, correlated with wound healing time. Future studies should consider using apoptosis markers and fluorescent labelling to ascertain if enhanced fat graft survival is due to proliferation or reduced apoptosis. Trial registration NCT03085550.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>34169656</pmid><doi>10.1111/iwj.13640</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-0220-3218</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adipocytes Adipose Tissue adipose‐derived stem cells Angiogenesis Animals Biopsy Cell growth Diabetes Diabetes Mellitus Diabetic Foot - surgery diabetic foot ulcers fat grafting Foot diseases Growth factors histology Humans Leg ulcers Original Platelet-Rich Plasma Statistical analysis Stem Cells Systematic review Variance analysis Wound Healing |
| title | Histological analysis of fat grafting with platelet‐rich plasma for diabetic foot ulcers—A randomised controlled trial |
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