This article aims to present the current state of knowledge in relation to the use of autologous platelet-rich plasma in various indications framed within the framework of Plastic, Aesthetic and Reconstructive Surgery. The clinical evidence accumulated so far indicates that the use of this therapy in the promotion of reparative phenomena associated with different plastic, aesthetic and repair surgical procedures induces the following effects: increase in the soft tissue and bone tissue repair processes, decrease of postoperative infection rates, pain and blood loss.
The knowledge of growth factors in clinical practice is not a new fact. Already from the works of Cohen and Levi-Montalcini (1) in the decade of the 50 in relation to nerve growth factors, which led to the award of the Nobel Prize in 1986, as well as the description of the epidermal growth factor by Cohen in 1962 (2), they represent two basic milestones in the development of this type of key treatment in reparative phenomena. Specifically in relation to the growth factors derived from platelets, the works by Raines and Ross (3) and Bowen-Pope and Ross (4) are noteworthy, in which the definition of them and their capacity are analyzed in detail. of binding to cultured cells. Since then, there have been multiple experiences in the clinic related to the use of platelet-rich autologous plasma (PRP) in the field of Plastic and Reconstructive Surgery, and even in the chapter of Cosmetic Surgery, as a coadjutant element in the infiltration of autologous fat in facial fillings (5), in the performance of facelifts (6) or in the treatment of chronic wounds.
What is the mechanism of action of the growth factors contained in the platelet-rich plasma and what kind of substances are we talking about? In a recent publication, Eppley et al. Carried out a meticulous study on the biology and applications of platelet-rich plasma in the field of Plastic Surgery. They reported that the proteins contained in the alpha granules of platelets have a strong influence on the reparative phenomena of wounds. Among these proteins are platelet derived growth factors (FCDP platelet derived growth factor or PDGF), transforming growth factor beta (FCT-β transforming growth factor or TGF-β), platelet factor 4 (FP4), interleukin 1 (IL-1), platelet derived angiogenic factor (FADP platelet derived angiogenic factor or PDAF), vascular endothelial growth factor (VEGF vascular endothelial growth factor or VEGF), epidermal growth factor (EGF epidermal growth factor or EGF), platelet-derived endothelial growth factor (FCEDP platelet derived endothelial growth factor or PDEGF), epithelial cell growth factor (ECCF), insulin-like growth factor (FCIL insulin-like growth) factor or IGF), osteocalcin, osteonectin, fibrinogen, fibronectin and thrombospondin (TSP). Platelets begin to actively secrete these substances 10 minutes after the formation of the clot, releasing more than 95% of the growth factors presyntized in the focus due to vascular growth promoted by platelets assume the regulation of tissue repair by secretion of their own factors.
The proteins secreted by platelets exert multiple actions on different aspects of tissue repair. Thus, PDGF is chemotactic for macrophages, PDGF, TGF-β and IGF also exert a chemotactic and mitogenic action on progenitor cells and osteoblasts as well as an angiogenic effect; They induce the formation of bone matrix and the synthesis of collagen. On the other hand, TGF-β and PDGF contribute to bone mineralization. Some of the proteins released by platelets are absent in chronic wounds that do not heal properly, which provides further evidence of the role of these substances in tissue repair.
Platelet-rich plasma is defined as a portion of the plasma itself with a platelet concentration higher than the baseline obtained by centrifugation. This plasma fraction contains not only a greater volume of platelets but also the factors responsible for coagulation. The obtained platelet concentration is established around 8 times the physiological concentration, which is in accordance with previously published experiences. All this type of actions has clinical effects that can be generally established in: increase in the soft tissue and bone tissue repair processes and decrease in postoperative infection rates, pain and blood loss.
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