When there is any damage to our body and there is a problem with healing, there are methods that we doctors use to accelerate healing from natural resources. Using biological agents is one of these methods.
Biological agents are roughly divided into 3.
1-Mesenchymal (precursor) stem cell: Bone marrow and fat tissue are the main sources of stem cells. Stem cells in the bone marrow are either prepared by aspirating and given to the damaged tissue, or bone marrow cells are tried to be brought directly to the damaged area with the microfracture technique used during surgery to solve some of the cartilage problems.
The other source other than bone marrow is fat, as I mentioned above. It is texture. For fat tissue, fat tissue cells taken from the abdomen or around the knee can be used and the resulting product is given to the damaged area.
2- PRP:
3-Growth. factors/cytokines
As can be seen, contrary to popular belief, PRP is not a stem cell, but is a useful product used in many areas.
The main source of PRP is platelets. Thrombocytes are shaped blood elements formed by precursor cells called megakaryocytes in the bone marrow. When they come out of the damaged vessel, they become activated, precipitate on the damaged area and form a clot. When platelets are activated, they form branches and spread around the damaged tissue. For this reason, activators are used in some PRP applications to accelerate the activation process.
At this stage, when activated, bioactive proteins, namely growth factors, that contribute to coagulation and tissue healing in platelets are secreted into the environment and thus play a key role in wound healing. They also activate white blood cells and remove dead cells from the tissue.
The most important and roughly functions of these growth factors, which are more than 30 in number and released into the environment from platelets, are as follows.
Platelet. derived growth factor (PDGF) - Accelerates cell separation and revascularization. It stimulates protein synthesis, collagen and matrix production in bone.
Vascularendothelialgrowth factor (VEGF) – accelerated revascularization rir
Transforming growth factor β group (TGF-β) – Approximately 303 factors are in this group. It plays a key role in fibrosis and muscle and bone cell balance. Fibroblastgrowth factor (FGF) – It is a stimulator for muscle cell proliferation
Epidermal growth factor (EGF) - It is an epithelial and mesenchymal cell enhancer
Hepatocyte growth factor (HGF) – Accelerates revascularization
Insulin-like growth factor (IGF)- Stimulates muscle and repair cells.
Since it is already present in the body, what is the purpose of using PRP?
Thrombocytes, which are normally between 150-400000 per ml in the blood, are given to the damaged area much more intensively than in the blood during the treatment with PRP. In other words, the aim is to place functional wound healers more intensively on the target area and try to increase the natural wound healing ability.
There is no evidence as to exactly how many platelets should be in the prepared liquid. The target is to capture 1 million platelets in 1 ml.
There are many PRP-related products and usage methods on the market. Among these:
-Amount of blood taken
-Feature of the tube from which the blood is taken
-Centrifuge time
-Number of centrifuges
-The anticoagulant agent used
-Presence of leukocytes in the preparation
-There are many differences regarding the use of activators. In fact, the common goal in all of them, as mentioned before, is to obtain dense platelets.
Due to these differences, the need for classification has arisen and PRP-containing fluids are roughly divided into 4 according to the presence of another blood cell called leukocyte.
1-Pure platelet rich plasma (P-PRP): That is, those containing only platelets without containing leukocytes. Example: Vivostat PRF, AnituaPRGF, Nahita, Arthrex PRGF.
2-Leukocyte and platelet rich plasma (L-PRP) containing both leukocytes and platelets. Example: Curasan, Regen, Plateltex, SmartPRP, PCCS, Magellan, GPS III.
3) Pure platelet rich fibrin (P-PRF) or leukocyte-poor platelet rich fibrin
Product form PRP, which is different but does not contain leukocytes. Example: fibrinet
4) Leukocyte and plateletrich fibrin (L-PRF) PRP with a different product shape and containing leukocytes. Example: Choukroun PRF
Leukocyte content in the product is a matter of disagreement among users. While some authors recommend having leukocytes, some authors do not. There are publications stating that the presence of leukocytes accelerates healing in some tendon problems.
PRP is also used in dentistry, maxillofacial surgery, plastic surgery, orthopedics, sports medicine, dermatology and cardiothoracic surgery. It can even be used for cosmetic purposes.
The main areas of use in orthopedics are tendon, muscle and cartilage problems, fracture healing, ligament injuries, shoulder problems and superficial wound problems.
As an absolute contraindication. Although it is not specified and there are no serious side effects published, it is not recommended for cancer patients and pregnancy.
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