A novel technique combining platelet gel, skin graft, and fibrin glue for healing recalcitrant lower extremity ulcers

Background There is no ideal procedure for the treatment of chronic skin ulcers. The use of platelet gel (PG) in this indication is raising interest. Objective To evaluate the safety and efficacy of a new procedure combining allogeneic single-donor PG and fibrin glue (FG) to enhance skin graft take for treating recalcitrant ulcers. Materials & Methods Fifteen patients with 17 ulcers of various etiologies were enrolled. Skin ulcers were débrided, and the wounds covered with moist saline dressing. Three to 14 days later, the wound bed was sprayed with PG, a thin split-thickness skin graft with multiple slits was put on the wound bed, and FG was sprayed on the skin graft. A short leg polypropylene splint was used to immobilize the skin graft. RESULTS Most skin grafts took well. The interval between skin graft and complete wound healing ranged from 3 weeks to 2 months. No recurrence of ulcers was noted during the 3- to 18-month follow-up period. No adverse reactions were observed. CONCLUSIONS The procedure provides advantages in skin grafting for recalcitrant ulcers because PG functions as a delivery system of powerful mitogenic and chemostatic factors and FG as a hemostatic tissue sealant that avoids the use of staples or sutures. The authors have indicated no significant interest with commercial supporters.