RT Generic T1 Plasma rico en plaquetas en el tratamiento local de úlceras de pie diabético difíciles de cicatrizar. Revisión bibliográfica narrativa T2 Platelet rich plasma in the local treatment of hard to heal diabetic foot ulcers. Narrative literature review A1 Lozano Serrano, Antonio AB Las úlceras de pie diabético (UPD) son la complicación más frecuente de la diabetes mellitus; aumentan el riesgo de infección, amputación de la extremidad inferior, y muerte. El tratamiento correcto de las UPD en base a la evidencia científica es de gran importancia para evitar dichas complicaciones, así como conseguir una cicatrización temprana. El uso del plasma rico en plaquetas (PRP) está en auge en la actualidad, y se ha evidenciado su ayuda en la cicatrización de heridas. Esta revisión bibliográfica narrativa se centra en los resultados y recomendaciones actuales del PRP en el tratamiento local de UPD difíciles de cicatrizar (“hard to heal diabetic foot ulcers”). A pesar de los buenos resultados en UPD crónicas, con trayecto fistuloso, y con invasión patógena bacteriana, es necesario protocolizar la composición y la posología aplicación del PRP. La combinación con biomateriales, o la liofilización, muestran una alentadora perspectiva de futuro. Se recomienda la elaboración de ensayos clínicos aleatorizados para dar luz a la efectividad del PRP en UPD. AB Diabetic foot ulcers (DFU) are the most common complication of diabetes mellitus; they increase the risk of infection, lower limb amputation, and death. The correct treatment of UPDs based on scientific evidence is of great importance to avoid such complications, as well as to achieve early healing. The use of platelet-rich plasma (PRP) is currently on the rise, and has been shown to aid in wound healing. This narrative literature review focuses on the current results and recommendations of PRP in the local treatment of difficult-to-heal DFUs. Despite good results in chronic DFU with fistulous tract and bacterial pathogenic invasion, the composition and dosage of PRP needs to be protocolised. The combination with biomaterials or freeze-drying is an encouraging prospect for the future. Randomised clinical trials are recommended to shed light on the effectiveness of PRP in DFU. YR 2023 FD 2023-05-01 LK https://hdl.handle.net/20.500.14352/3359 UL https://hdl.handle.net/20.500.14352/3359 LA spa NO 1. Alberti KGMM, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabetic Medicine [Internet]. 1998 Jul [cited 2022 Dec 3];15(7):539–53. Available from: https://onlinelibrary.wiley.com/doi/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S2. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care [Internet]. 2014 Jan 1 [cited 2022 Dec 3];37(1). Available from: http://diabetesjournals.org/care/article-pdf/37/Supplement_1/S81/485942/s81.pdf by guest on 03 December 20223. Monteiro‐Soares M, Russell D, Boyko EJ, Jeffcoate W, Mills JL, Morbach S, et al. Guidelines on the classification of diabetic foot ulcers (IWGDF 2019). Diabetes Metab Res Rev [Internet]. 2020 Mar 16 [cited 2022 Dec 8];36(S1). Available from: https://onlinelibrary.wiley.com/doi/10.1002/dmrr.32734. Tirado RADC, Antonio Fernández López J, Javier F, Tirado DC. Guía de práctica clínica en el pie diabético. 2014 [cited 2022 Dec 8];10:1. Available from: http://journals.imedpub.comEsteartículoestadisponibleen:www.archivosdemedicina.com5. Forbes JM, Cooper ME. Mechanisms of diabetic complications [Internet]. Vol. 93, Physiological Reviews. 2013 [cited 2022 Dec 3]. Available from: https://journals.physiology.org/doi/full/10.1152/physrev.00045.20116. Ullah A, Jawaid SI, Qureshi PNAA, Siddiqui T, Nasim K, Kumar K, et al. Effectiveness of Injected Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcer Disease. Cureus [Internet]. 2022 Aug 23 [cited 2023 Feb 4];14(8):e28292. Available from: http://www.ncbi.nlm.nih.gov/pubmed/361584227. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nat Rev Dis Primers [Internet]. 2020 May 14 [cited 2022 Dec 8];6(1):40. Available from: https://www.nature.com/articles/s41572-020-0165-18. American Diabetes Association. 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2018. Diabetes Care [Internet]. 2018 Jan 1 [cited 2022 Dec 6];41(Supplement_1):S137–43. Available from: https://diabetesjournals.org/care/article/41/Supplement_1/S137/29804/13-Management-of-Diabetes-in-Pregnancy-Standards9. Netten JJ, Bus SA, Apelqvist J, Lipsky BA, Hinchliffe RJ, Game F, et al. Definitions and criteria for diabetic foot disease. Diabetes Metab Res Rev [Internet]. 2020 Mar 14 [cited 2022 Dec 8];36(S1). Available from: https://onlinelibrary.wiley.com/doi/10.1002/dmrr.326810. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. Ingelfinger JR, editor. New England Journal of Medicine [Internet]. 2017 Jun 15 [cited 2022 Dec 6];376(24):2367–75. Available from: http://www.nejm.org/doi/10.1056/NEJMra161543911. Malekpour Alamdari N, Shafiee A, Mirmohseni A, Besharat S. Evaluation of the efficacy of platelet-rich plasma on healing of clean diabetic foot ulcers: A randomized clinical trial in Tehran, Iran. Diabetes & Metabolic Syndrome: Clinical Research & Reviews [Internet]. 2021 Mar [cited 2022 Dec 8];15(2):621–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S187140212100073412. Gonchar IV, Lipunov AR, Afanasov IM, Larina V, Faller AP, Kibardin AV. Platelet rich plasma and growth factors cocktails for diabetic foot ulcers treatment: State of art developments and future prospects. Diabetes & Metabolic Syndrome: Clinical Research & Reviews [Internet]. 2018 Apr [cited 2022 Dec 10];12(2):189–94. Available from: https://linkinghub.elsevier.com/retrieve/pii/S187140211730294113. Hu Z, Qu S, Zhang J, Cao X, Wang P, Huang S, et al. Efficacy and Safety of Platelet-Rich Plasma for Patients with Diabetic Ulcers: A Systematic Review and Meta-analysis. Adv Wound Care (New Rochelle) [Internet]. 2019 [cited 2022 Dec 8];8(7):298–308. Available from: https://www.liebertpub.com/doi/10.1089/wound.2018.084214. Álvaro-Afonso FJ, García-Morales E, López-Moral M, Alou-Cervera L, Molines-Barroso R, Lázaro-Martínez JL. Comparative Clinical Outcomes of Patients with Diabetic Foot Infection Caused by Methicillin-Resistant Staphylococcus Aureus (MRSA) or Methicillin-Sensitive Staphylococcus Aureus (MSSA). https://doi.org/101177/15347346221094994 [Internet]. 2022 Apr 13 [cited 2023 Mar 21]; Available from: https://journals.sagepub.com/doi/10.1177/1534734622109499415. Alves R, Grimalt R. A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification. Skin Appendage Disord [Internet]. 2018 Jan 1 [cited 2022 Dec 8];4(1):18–24. Available from: https://pubmed.ncbi.nlm.nih.gov/29457008/16. Naves CCLM. The Diabetic Foot: A Historical Overview and Gaps in Current Treatment. Adv Wound Care (New Rochelle) [Internet]. 2016 May [cited 2023 Feb 4];5(5):191–7. Available from: http://www.liebertpub.com/doi/10.1089/wound.2013.051817. Wroblewski AP, Mejia HA, Wright VJ. Application of Platelet-Rich Plasma to Enhance Tissue Repair. Oper Tech Orthop [Internet]. 2010 Jun [cited 2022 Dec 8];2(20):98–105. Available from: https://www.infona.pl//resource/bwmeta1.element.elsevier-dabde32f-0b0b-37b8-b650-1736568bac6718. Wang S, Yang J, Zhao G, Liu R, Du Y, Cai Z, et al. Current applications of platelet gels in wound healing—A review. Wound Repair and Regeneration [Internet]. 2021 May 22 [cited 2023 Feb 4];29(3):370–9. Available from: https://onlinelibrary.wiley.com/doi/10.1111/wrr.1289619. Rainys D, Cepas A, Dambrauskaite K, Nedzelskiene I, Rimdeika R. Effectiveness of autologous platelet-rich plasma gel in the treatment of hard-to-heal leg ulcers: a randomised control trial. J Wound Care [Internet]. 2019 Oct 2 [cited 2023 Feb 4];28(10):658–67. Available from: http://www.magonlinelibrary.com/doi/10.12968/jowc.2019.28.10.65820. Rao SS, Venkatesan J, Prabhu A, Rekha PD. Natural polymeric biomaterials in growth factor delivery for treating diabetic foot ulcers. J Drug Deliv Sci Technol [Internet]. 2020 Feb [cited 2023 Feb 6];55:101385. Available from: https://linkinghub.elsevier.com/retrieve/pii/S177322471930703821. Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, de Ceniga MV, et al. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care [Internet]. 2020 Mar 1 [cited 2023 Feb 5];29(Sup3b):S1–26. Available from: http://www.magonlinelibrary.com/doi/10.12968/jowc.2020.29.Sup3b.S122. Rajendran S, Thiyagarajan M, K. BS, Navrathan N. A comparative study on effect of platelet rich plasma Vs conventional dressing in healing rate of chronic diabetic ulcers. Biomedicine (Taipei) [Internet]. 2021 Dec 31 [cited 2023 Feb 4];41(4):849–54. Available from: https://biomedicineonline.org/index.php/home/article/view/12123. Tizón-Bouza E, Pazos-Platas S, Álvarez-Díaz M, Marcos Espino M.P., Quintela-Varela ME. Cura en ambiente húmedo en úlceras crónicas a través del Concepto TIME. Recomendaciones basadas en la evidencia. Trabajos de Investigación. Enfermería dermatológica [Internet]. 2013 [cited 2023 Feb 23];20(septiembre-diciembre):31–42. Available from: https://dialnet.unirioja.es/servlet/articulo?codigo=479004924. Andia I, Perez-Valle A, Del Amo C, Maffulli N. Freeze-Drying of Platelet-Rich Plasma: The Quest for Standardization. Int J Mol Sci [Internet]. 2020 Sep 20 [cited 2023 Feb 23];21(18):6904. Available from: https://www.mdpi.com/1422-0067/21/18/690425. Xie J, Fang Y, Zhao Y, Cao D, Lv Y. Autologous Platelet-Rich Gel for the Treatment of Diabetic Sinus Tract Wounds: A Clinical Study. Journal of Surgical Research [Internet]. 2020 Mar [cited 2023 Feb 22];247:271–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S002248041930730926. He M, Chen T, Lv Y, Song P, Deng B, Guo X, et al. The role of allogeneic platelet-rich plasma in patients with diabetic foot ulcer: Current perspectives and future challenges. Front Bioeng Biotechnol [Internet]. 2022 Sep 29 [cited 2023 Feb 23];10. Available from: https://www.frontiersin.org/articles/10.3389/fbioe.2022.993436/full27. Singh SP, Kumar V, Pandey A, Pandey P, Gupta V, Verma R. Role of platelet-rich plasma in healing diabetic foot ulcers: a prospective study. J Wound Care [Internet]. 2018 Sep 2 [cited 2023 Feb 8];27(9):550–6. Available from: http://www.magonlinelibrary.com/doi/10.12968/jowc.2018.27.9.55028. Henning PR, Grear BJ. Platelet-rich plasma in the foot and ankle. Curr Rev Musculoskelet Med [Internet]. 2018 Dec 26 [cited 2023 Feb 13];11(4):616–23. Available from: http://link.springer.com/10.1007/s12178-018-9522-z29. Mastrogiacomo M, Nardini M, Collina MC, Di Campli C, Filaci G, Cancedda R, et al. Innovative Cell and Platelet Rich Plasma Therapies for Diabetic Foot Ulcer Treatment: The Allogeneic Approach. Front Bioeng Biotechnol [Internet]. 2022 May 2 [cited 2023 Feb 23];10. Available from: https://www.frontiersin.org/articles/10.3389/fbioe.2022.869408/full30. Linertová R, del Pino-Sedeño T, Pérez LG, Aragón-Sánchez J, Andia-Ortiz I, Trujillo-Martín M, et al. Cost-effectiveness of Platelet-Rich Plasma for Diabetic Foot Ulcer in Spain. Int J Low Extrem Wounds [Internet]. 2021 Jun 10 [cited 2023 Feb 3];20(2):119–27. Available from: http://journals.sagepub.com/doi/10.1177/153473462090323931. Elsaid A, El-Said M, Emile S, Youssef M, Khafagy W, Elshobaky A. Randomized Controlled Trial on Autologous Platelet-Rich Plasma Versus Saline Dressing in Treatment of Non-healing Diabetic Foot Ulcers. World J Surg [Internet]. 2020 Apr 6 [cited 2023 Feb 13];44(4):1294–301. Available from: http://link.springer.com/10.1007/s00268-019-05316-032. Li T, Ma Y, Wang M, Wang T, Wei J, Ren R, et al. Platelet-rich plasma plays an antibacterial, anti-inflammatory and cell proliferation-promoting role in an in vitro model for diabetic infected wounds. Infect Drug Resist [Internet]. 2019 [cited 2023 Feb 4];12:297–309. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3077439733. Qu W, Wang Z, Hunt C, Morrow AS, Urtecho M, Amin M, et al. The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds. Mayo Clin Proc [Internet]. 2021 Sep [cited 2023 Feb 4];96(9):2407–17. Available from: https://linkinghub.elsevier.com/retrieve/pii/S002561962100166X34. del Pino-Sedeño T, Trujillo-Martín MM, Andia I, Aragón-Sánchez J, Herrera-Ramos E, Iruzubieta Barragán FJ, et al. Platelet-rich plasma for the treatment of diabetic foot ulcers: A meta-analysis. Wound Repair and Regeneration [Internet]. 2019 Mar [cited 2023 Feb 23];27(2):170–82. Available from: https://onlinelibrary.wiley.com/doi/10.1111/wrr.1269035. Orban Y, Soliman M, Hegab Y, Alkilany M. Autologous Platelet-rich Plasma vs Conventional Dressing in the Management of Chronic Diabetic Foot Ulcers. Wounds [Internet]. 2022 Feb 15 [cited 2023 Feb 4];34(2):36–42. Available from: https://www.hmpgloballearningnetwork.com/site/wounds/original-research/autologous-platelet-rich-plasma-vs-conventional-dressing-management36. Shen Z, Zheng S, Chen G, Li D, Jiang Z, Li Y, et al. Efficacy and safety of platelet‐rich plasma in treating cutaneous ulceration: A meta‐analysis of randomized controlled trials. J Cosmet Dermatol [Internet]. 2019 Apr 26 [cited 2023 Feb 23];18(2):495–507. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jocd.1285337. Dai J, Jiang C, Sun Y, Chen H. Autologous platelet-rich plasma treatment for patients with diabetic foot ulcers: a meta-analysis of randomized studies. J Diabetes Complications [Internet]. 2020 Aug [cited 2023 Feb 23];34(8):107611. Available from: https://linkinghub.elsevier.com/retrieve/pii/S105687272030367638. Xia Y, Zhao J, Xie J, Lv Y, Cao DS. The Efficacy of Platelet-Rich Plasma Dressing for Chronic Nonhealing Ulcers: A Meta-Analysis of 15 Randomized Controlled Trials. Plast Reconstr Surg [Internet]. 2019 Dec 1 [cited 2023 Feb 4];144(6):1463–74. Available from: https://journals.lww.com/10.1097/PRS.000000000000628139. Gong F, Zhang Y, Gao J, Li X, Zhang H, Ma G, et al. Effect of platelet‐rich plasma vs standard management for the treatment of diabetic foot ulcer wounds: A meta‐analysis. Int Wound J [Internet]. 2023 Jan 25 [cited 2023 Feb 13];20(1):155–63. Available from: https://onlinelibrary.wiley.com/doi/10.1111/iwj.1385840. Sridharan K, Sivaramakrishnan G. Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials. Br J Clin Pharmacol [Internet]. 2018 Mar [cited 2023 Feb 23];84(3):434–44. Available from: https://onlinelibrary.wiley.com/doi/10.1111/bcp.1347041. Li Y, Gao Y, Gao Y, Chen D, Wang C, Liu G, et al. Autologous platelet‐rich gel treatment for diabetic chronic cutaneous ulcers: A meta‐analysis of randomized controlled trials. J Diabetes [Internet]. 2019 May 14 [cited 2023 Feb 13];11(5):359–69. Available from: https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.1285042. Hirase T, Ruff E, Surani S, Ratnani I. Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review. World J Diabetes [Internet]. 2018 Oct 15 [cited 2023 Feb 4];9(10):172–9. Available from: http://www.wjgnet.com/1948-9358/full/v9/i10/172.htm DS Docta Complutense RD 1 may 2024