Focus of the Report: This health technology assessment focuses on the use of platelet-rich plasma (PRP) for treatment of diabetic foot ulcers (DFUs).

Technology Description: PRP is an autologous blood preparation with a higher-than-usual concentration of platelets, platelet-derived growth factors, and other cytokines. Protocols for PRP preparation vary considerably but usually entail centrifugation of whole blood obtained from the patient to separate platelets from other blood components. PRP in liquid form can be applied to the DFU surface or injected into and around DFUs. In addition, the platelets can be activated to form a topical gel that is applied onto DFUs. Treatment is typically delivered in an outpatient wound management facility.

Controversy: Conventional wound therapy (CWT) is an efficacious and established first line of treatment for DFUs. However, 10% to 15% of patients fail to respond to CWT. Chronic refractory DFUs are more expensive, more dangerous, and harder to treat than acute foot wounds. PRP may have a potential role in supplementing the care of patients with hard-to-heal foot ulcers, but unresolved questions remain regarding cost-effectiveness, ideal preparation methods, and optimal patient selection criteria.

Key Questions:

  • Does PRP accelerate the healing of DFUs?

  • How does adjunct PRP performed alongside CWT compare with standalone CWT for treating DFUs?

  • Is PRP therapy associated with any safety issues?

  • Have definitive patient selection criteria been identified for PRP?

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