Category: Clinical Sciences/Health Conditions
Neuropathic ulcer results from repetitive trauma to hyposensate distal extremities, usually on weight-bearing bony prominences. Non-healing ulcers have a significant impact on the personal, professional and social level of an individual. Autologous platelet-rich plasma contains fibrin and high concentration of growth factors and has the potential to aid wound healing. In a clinical setting, the practice of using autologous PRP is trending but needs more supportive evidence. This case report documents management of chronic non-healing neuropathic ulcer on dorsum of the left foot with equino-varus deformity in a child of spinal dysraphism.
An 11-year-old male child with paraplegia, left equino-varus deformity with dorsal foot ulceration, as sequalae to spinal dysraphism was brought by mother for rehabilitation treatment. The ulcer wasn’t responding to the traditional approach of wound healing along with off-loading. With the informed consent of parents autologous PRP therapy was planned for wound healing. Wound therapy with the local application of autologous PRP using a double centrifuge technique was done once a week for 3 times. A below-knee plaster cast was given as protective dressing with complete offloading. Treatment response was monitored with pressure ulcer scale for healing (PUSH 3.0).
The wound area, exudate and tissue type was documented in weekly follow up using PUSH scale. The initial score was 13 which reduced to 7 after 3 weekly sessions of PRP therapy. A total score of 0 with PUSH scale was achieved at the end of 5th week suggestive of complete wound healing.
Advanced wound therapy with the local application of autologous PRP seems to be a promising alternative to traditional wound-healing techniques with biocompatible safety and significant clinical efficacy. Large scale studies are needed to establish it as an ideal therapy for chronic non-healing wound management.
Ameya Joshi– Senior Resident, All India Institute of Physical Medicine & Rehabilitation, Mumbai
Sumedh More– Asst. Professor, All India Institute of Physical Medicine and Rehabilitation, Mumbai.
Amit Mhambre– Head of the Department PMR, All India Institute of Physical Medicine and Rehabilitation, Mumbai.