Diabetes Mellitus welcomes several diseases due to over time exposure to high blood glucose; which may damage some of the most functional organs such as nerves, kidneys, eyes and blood vessels. It can also decrease the bodyâ€™s ability to fight infection. One of the obvious, significant and rapidly growing complications of diabetes is Diabetic Foot Ulcers and delayed wound healing.
In case of a severely affected immune system, normal foot problem can quickly become serious. With damage to the nervous system, a diabetic person may be unable to feel his fleet properly, additionally normal sweat secretion and oil production responsible for skin lubrication is decreased. All these factors can collectively apply pressure on the foot while walking which may lead to the severe breakage of skin. Damage to the blood vessels and compromised immunity can delay the healing process. Due to prolonged exposure of skin surface to the outer atmosphere, there can be a serious bacterial infection of skin, connective tissues, muscles, bone which may cause gangrene. Due to poor blood flow, antibiotics cannot work well, leaving behind the only option; is to amputate the leg to avoid life threatening consequences due to spreading of infection.
Despite the advances in treatment options, the outcomes for the patients with DFUâ€™s have not improved. The successful treatment is hindered by the lack of targeted therapy that hones in on the healing processes deregulated by diabetes. In that regard, PRP can be a promising tool, being capable of bypassing the underlying abnormal healing mechanism as well as accelerating the initial healing stages such as inflammation, seceretion of immune cells and proliferation of damaged cells.
Major Manifestations of Diabetic Foot, in patients include the following:
- Stage I: It is the beginning stage of the sore with the characteristics such as red patch on the skin, the area of the affected skin may be tender, painful, firm, soft, warm compared with the surrounding tissue.
- Stage II: The outer layer of the skin( Epidermis) or part of the underlying layer such as dermis will start damaging or will get lost due to which the wound may look like a fluid filled blister
- Stage III: The ulcer will be like a deep wound, usually exposing some fat. The bottom of the wound may have some yellowish dead tissue
- Stage IV: The ulcer will involve large scale loss of tissue involving muscles, bones, tendons. The dead tissue will be yellowish, dark or crusty
The symptoms fall into one of four stages based on their severity, they may be
With the advancing technology, the treatment implementing Platelet Rich Plasma, is gaining popularity as a biological booster to accelerate body's delayed healing mechanism and maximise cell proliferation. The use of PRP is a very efficient technique being employed since 1990's to promote healing of the soft tissues as well as wounds and is categorically attracting many doctors, due to it's incredible outcomes; that have been observed through various clinical trials The PRP is a platelet concentrate with liquid plasma portion containing various essential growth factors, important to promote cell recruitment, multiplication as well as specialization, for faster healing. The PRP injections are prepared from the patient's own peripheral blood under strict asceptic conditions, following good laboratory practices. It is one of the best point of care technologies, exploiting patient's own activated platelets; that when infused back into the patient, can release various growth factors at the site of injury. This can in turn stimulate the microenvironment, cytokines and resident stem cells to boost initial healing processes such as inflammation, repair and remodelling. Various studies have indicated that the PRP shots have augmented healing, improved function by promoting the proliferation of reparative cells and reduce the pain associated with various maladies including but not limited to orthopaedic, wound healing, diabetic foot and sports injuries. So far so good, no adverse effects have been reported nor have we came across any after the PRP treatment, as we are exploiting patient's own blood, for which they should have no reaction to!
PRP Treatment For Diabetic Foot: Advancells Protocol
The treatment at Advancells is focused mainly on improving the patientâ€™s quality of life along with repairing the damaged tissues and restoring its lost function. For the diabetic foot, wounds and other open sore; we have designed a specialized treatment that employes patient's own PRP. Which is actually a plasma rich in the platelets. These pletelets can secrete growth factors and cytokines enabling faster healing and regeneration of damaged cells.Various studies have confirmed that the platelets play a pivotal role in the process of wound healing by initiating the inflammation. Our top priority is thus to provide very comprehensive, individualized treatment pattern which is best suited for the patients undergoing treatment, aiming their maximum recovery; according to the pathophysiology of the injury.
At Advancells, in choosing the treatment strategy, we give special consideration to the stage of wound and accordingly the purpose of the treatment such as protection, moisturization, removal of necrotic tissue etc. An algorithm for assessment and treatment is made accordingly. As a part of our treatment, patient's peripheral blood is withdrawn to prepare autologous plasma concentrate highly rich in platelets possessing various growth factors. In general for the treatment of DFU, PRP is infused locally around the wound to speed up the process of effective healing.
Step 1- Qualification For The Treatment
A safety and efficacy assessments will be prescribed by our experts in order to investigate the stage of severity and qualify the patient for the treatment. Following pretreatment assessments can be suggested depending upon the patient's medical and family background:
Pre-Treatment Assessments Wounds
- Infectious Disease Testing
- Routine Blood tests
- Physical Examination
- Urine analysis
- X ray
- Non Invasive Vascular Studies
- X ray
- Medical Reports & History
As per these results, the patient will be counseled further for final decision of protocol.
Step 2- Source Extraction
PRP is rich platelet concentrate, with the seven essential protein growth factors which can rapidly initiate cascade of reactions for wound healing; additionally it includes three very fundamental proteins that can act as a "Cell Adhesion Molecules" to activate signal transmission. This activation can express the gene, directing the cellular proliferation, matrix formation, osteoid formation and collagen synthesis; which promote tissue repair and regeneration. Reasearch has as well confirmed that after injection in the body, PRP can actively secrete the growth factors within 10 mins while more than 95% of them are secreted within 1 hr after activation.
If you are curious to know more about the procedure, kindly refer our detailed snapshot below:
Step 3- Laboratory Processing
PRP is generally obtained from the peripheral blood of the patient drawn at the time of treatment. Approximately 30CC will be drawn from the patient depending upon the baseline platelet count of the individual.In order to prevent unnecessary activation of platelet, the venous blood of the patient will be collected using suitable anticoagulent. A specialized process will be employed to separate the platelet rich plasma from the whole blood of the patient; which is then infused around the wound or other targeted area under the guidance of specialist to promote faster wound healing.
The sample will undergo minimum manipulation to be enriched with the pure population of platelet; which would the best possible treatment for faster wound healing.
Step 4- Implantation
Once the PRP ready to be injected back into the body, we generally put them back through local intradermal administration through syringes around the wound.
- Intra-Dermal Administration:- The technique is used in case of open sores, wherein PRP will be infused locally in and around the wound area.
Follow up Treatment
Post treatment, the patient will be asked to visit the doctors for reclamation therapies such as Physiotherapy, patients counselling etc. for accelerated recovery.
Diabetic Foot Treatment Results
Patients, who have undergone a PRP treatment with Advancells for their wounds such as diabetic foot have acquired a very fast recovery. All of them were suffering from non healing diabetic foot during their late 50's as a major complication of Diabetes. Since the management of the wound in diabetic patients is very poor and painful, a kind of advanced technology was suggested for them as a treatment to manage the problem; which can easily take over to traditional options such as surgeries, debridement, antibacterial actions etc. A PRP was isolated from the peripheral blood of all the patients and injected around the wound through microneedles. The results showed that 100% ulcers completely closed after about 7-8 weeks. Although, patients response to the wounds was not typical; no adverse effect has been observed till now. The method is completely authentic, approved by the regulatory authority as a novel and minimally invasive method.
" In 2006, when Mr. Ramesh Sharma had been diagnosed with the diabetes, his family were shocked with the news! He was a fit, healthy man with happy family and work life. Mr. Ramesh began with the treatment that was progressing effectively. However the treatment left him with the severe diabetic foot wound on his right leg. The wound was causing him severe pain disturbing his routine life. He had previously sought treatment at different centers before finally being referred to Advancells........"
Frequently Asked Questions
- What is PRP?
- PRP is the platelet Rich Plasma. Plasma is the liquid component of the blood, which serves as the host for all the cellular components of the blood like red blood cells, white blood cells and platelets. Thus platelets naturally make up about 10% of the bloodâ€™s cellular component. With the help of a technology, it is possible to flip the ratio of platelets upto 90% concentration. Therefore it is named as the Platelet Rich Plasma.
- What is PRP treatment and how does it work?
- Platelets are known as the first respondents after the injury. Immediately after the injury, the human body starts eliciting an immune response allowing platelets and other immune components to migrate at the site of injury. At the targeted site, these platelets are known to secrete various growth factors and clotting factors to initiate the healing process, promote blood vessels formations as well as collagen synthesis. These platelets are also known to trigger the secretion of many bioactive molecules, which can attract many macrophages, mesenchymal stem cells and osteoblasts. PRP is a non surgical healing treatment used in the field of regenerative medicines to stimulate and enhance healing. In a simple language, PRP is considered as the mega doses prepared from the ingredients of our own body for our own healing.
- What types of conditions are treated with PRP? Based on the current research, all the orthopaedic related problems such as soft tissue injuries, tendonitis, ligament sprains and muscle tears can be treated well with PRP treatment. It is as well found to be very useful in anti aging treatment, hair restoration and wound healing such as diabetes foot.
- Is PRP treatment painful?
- Patient typically tolerates the treatment well both with and without anaesthesia. However post injection swelling in expected given the PRP induced inflammatory response. But these discomforts such as swelling are observed in the typical injected area which will not be for more than 48 hrs.
- How long does it take the PRP to work?
- Many of the people have notices some or the other kind of improvement depending upon the problem by 2-3 weeks after the PRP treatment. Symptom improvement has been observed to be slow and subtle with the passage of time, with usual complaint of original pain being replaced by the soreness. Increased endurance and strength are typical observation immediately after the treatment.
- Preparation of PRP?
- A small amount of blood is withdrawn generally 30 ml from the peripheral vein of the patient. The blood is then placed in the centrifuge, to separate platelet from rest of the components. On the therapeutic aspects, platelet count is enriched 5 fold with 10-15 fold decrease in the volume after the processing. The entire process takes not more than 20 mins to increase the concentration of platelet along with the inherent stimulation of stem cells for quick proliferation, differentiation and regeneration. The concentrated PRP is then injected around the area or in the joints to speed up the process of healing. 21/01/2017