Journal of Orthopaedics and Allied Sciences

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 4  |  Issue : 1  |  Page : 5--7

STARS therapy: "Sandeep's technique for assisted regeneration of skin"


Sandeep Shrivastava, Pradeep K Singh, Shounak Taywade 
 Department of Orthopaedics, J.N. Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Correspondence Address:
Dr. Sandeep Shrivastava
Department of Orthopaedics, J.N. Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra
India

Abstract

Background: The wound management is a huge complex problem consuming billions of dollars. The standard treatment includes advance therapeutics with drugs (such as antibiotics), intense local dressings (such as negative pressure/antimicrobial) and multiple surgical interventions/reconstructions. Such intervention and modalities requires experts and large resources. Still the outcomes are unpredictable and associated with morbidities at donor (otherwise normal) sites. Materials and Methods: The «DQ»Sandeep«SQ»s Technique«SQ»s for Assisted Regeneration of Skin«DQ» (STARS) is therapy for complete healing of wounds with Autologous self activated Platelet Rich Plasma (PRP), imparted as local subcutaneous infiltrate in the wound margin, on every 4 th day, till complete repair takes place and local skin regenerates. The wounds are dressed daily/alternate day with only moist saline. It is a Pilot study of patients treated with STARS Therapy treated at Acharya Vinobha Bhave Rural Hospital, J.N.Medical College, Wardha, INDIA. The different types of wounds were acute wounds with exposed deep tissues such tendons and bones; compound fractures; infected wounds; necrotising post surgical flaps and chronic non healing ulcers including diabetic and pressure ulcers. Result: All the wounds healed aby PRP infiltration not requiring any further drugs, complex dressings and surgical reconstruction. Conclusion: It is safe, effective, efficient, and easily reproducible technique with predictable results for even complex wounds in which surgical reconstructions are not possible. This method of treatment is a huge step forward in preservation of resources and prevention of morbidity.



How to cite this article:
Shrivastava S, Singh PK, Taywade S. STARS therapy: "Sandeep's technique for assisted regeneration of skin".J Orthop Allied Sci 2016;4:5-7


How to cite this URL:
Shrivastava S, Singh PK, Taywade S. STARS therapy: "Sandeep's technique for assisted regeneration of skin". J Orthop Allied Sci [serial online] 2016 [cited 2020 Dec 1 ];4:5-7
Available from: https://www.joas.in/text.asp?2016/4/1/5/180688


Full Text

 Introduction



Wounds are at times very complex problem to deal with as it may get associated with chronicity, comorbidities such as diabetes, nonhealing, persistent infections and poor local biology such as loss of sensations. These are very difficult to manage and needs multiple modalities including complex local care such as with negative pressure therapy, antimicrobial dressings; antibiotics and multiple stage surgeries such as debridements, reconstructions with skin gratings, rotational flap or free flaps. [1] Such modalities are associated with further morbidities of the donor site, risks and side effects of pharmacological agents, antibiotic resistance, etc.

Ross et al. [2] first described growth factor from platelets. The regenerative medicine as being evolved in this era, offers a strong ray of hope to overcome many diseases. The key regenerative biologic product includes stem cells, mesenchymal cells, and platelets. Platelet as blood product is being used as platelet rich plasma (PRP) and have very promising results for the treatment of various impairments including of tendons and bones. [3],[4] It is also used as local gel application for local care in the treatment of wounds, concurrent (adjunct) to existing wound management practices. [4],[5],[6],[7],[8] The early results, as reported in literature are encouraging. [9],[10]

 Materials and Methods



The authors have developed a novel therapy "Sandeep's technique for assisted regeneration of skin" (STARS) which for the first time uses autologous PRP as local infiltration's for wound healing and as a definitive therapy for wound management. This therapy uses autologous PRP as the regenerative product for assisting the natural wound healing. The "STARS" is intended to be the biotechnological intervention for assisting the skin regeneration and subsequent wound coverage, leading to complete wound healing.

The technical details are as following:

a. Preparation of PRP

Out of very many methods being developed for PRP separation and preparation, we have chosen the following, as it is simplest and can be easily reproduced with minimum and low-cost equipment.

This is as following:

This is a standard double spin method, using 20 ml of venous autologus blood, freshly drawn from the patient. The 5 mL blood is then transferred to 4 EDTA test tubes each and centrifuged at 2000 rpm for 15 minutes. RBCs will be settled in the lower portion of test tube where as plasma in upper part. Plasma is extracted and collected in separate test tube and further re-centrifuged at 1200 rpm for 10 minutes. The plasma further separates into upper buffy coat which platelet poor plasma (PPP) and the lower 2-4 mL layer containing platelet rich plasma (PRP).

The centrifuge machine used is simple noncooled one. The centrifuge process is standard with balancing tubes in place. The process is performed at a room temperature of 22-24°C.

This autologous PRP is then utilized as the standard regenerative biologic product for STARS therapy.

b. "STARS" therapy protocol

The protocol involves following:

This Autologous PRP is then transferred to a 10 ml syringe and locally infiltrated in the wound margins through a 22 G needle, just like a local infiltration of local anesthesia, at a distance of approximately 0.2 mL/cm with equal quantityThe process is repeated every 4 th day (gap of 3 days)Local dressing is performed on alternate days, with moist saline onlyDiluted Cetrimide and chlorhexidine gluconate solution (Savlon) both are given to wounds that are dirtyNo further major surgical intervention such as debridements or reconstructions with flaps/grafts are undertakenNo antibiotics are given unless life-threatening or for treating any co-morbid infections. From infected wounds swabs are taken for culture and sensitivity every week, to monitor the infection status of woundNo analgesics are given unless the pain visual analog scale score is 7 or moreOnly Vitamin C tablets twice daily are given.

It is an innovative therapy with autologous PRP as a monotherapy.

The current mode and manner include uses 50 ml of venous blood, than further activation of PRP, development of it as a gel and local application of this gel over the wound (mostly every 7 th day). This is carried along with the standard treatment of wound, which goes concurrently. The current focus is using PRP as a local application over wounds than as a definitive regenerative therapy.

STARS therapy has distinct advantages, as it focus on the simple manner of preparation, uses a low volume of venous blood (only 20 ml) and is infiltrated in the wound margins. It is used as definitive therapy for tissue repair and regeneration without the use of intense local care, antibiotics, and further surgeries.iogure

The STARS therapy is an entirely different concept. It is basically based on utilizing the growth factors (such as vascular and endothelial) inflammatory and phagocytic (ILN4, ILN6, alpha tumor necrosis factor, etc.,) [11] and antimicrobial properties [12] of PRP for enhancing wound healing in a natural way and assisting the regeneration of skin from the margins.

It is developed with the intention of keeping it reproducible at all level of health care including primary, which can be imparted by any trained physician, who have accessibility to a low rpm centrifuge machine, which in Indian market costs only Rs. 25,000-35,000.

We have used this technique for management of many types of wounds with excellent results.

 Results



Twenty patients were prospectively included in the study and were given PRP infiltration according to above protocol. The mean age of patients was 40 and average PRP infiltrations required were 9. All wounds showed encouraging signs of healing and healed almost completely. The wound healing was achieved in patients with juvenile diabetic with non healing ulcer [Figure 1]. Excellent wound coverage was observed in patients with compound fractures and bone deep pressure sores in paraplegic patients where flap surgery was advised by the plastic surgeon [Figure 2] and [Figure 3]. No complications were seen during the course of study.{Figure 1}{Figure 2}{Figure 3}

 Discussion



The regenerative medicine holds promising future to many untreatable and complex problems.

The current solutions and treatment are associated with unpredictable results and involves huge resources including involvement of expert care, which is not available at all the places.

The current treatment with regenerative biologic products is costly, limited to few places and cannot be imparted by everyone as it involves complex cell culture processes.

This "STARS" therapy with autologous PRP as biotechnological intervention for wound management is safe as its uses autologous venous blood; is easily reproducible; can be widely accessed and is effective; leading to complete healing.

It has the potential to be the game changer and perhaps the ideal management for wounds without the involvement of any pharmacological drugs/devices and their risks; any major surgical interventions and its morbidities; any need for experts and hence restricting the accessibilities.

It is perhaps also far much cheaper than current standard care of the wound.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Sarvajnamurthy S, Suryanarayan S, Budamakuntala L, Suresh DH. Autologous platelet rich plasma in chronic venous ulcers: Study of 17 cases. J Cutan Aesthet Surg 2013;6:97-9.
2Ross R, Glomset J, Kariya B, Harker L. A platelet-dependent serum factor that stimulates the proliferation of arterial smooth muscle cells in vitro. Proc Natl Acad Sci U S A 1974;71:1207-10.
3Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004;91:4-15.
4Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med 2011;39:1200-8.
5de Leon JM, Driver VR, Fylling CP, Carter MJ, Anderson C, Wilson J, et al. The clinical relevance of treating chronic wounds with an enhanced near-physiological concentration of platelet-rich plasma gel. Adv Skin Wound Care 2011;24:357-68.
6Kazakos K, Lyras DN, Verettas D, Tilkeridis K, Tryfonidis M. The use of autologous PRP gel as an aid in the management of acute trauma wounds. Injury 2009;40:801-5.
7Mazzucco L, Medici D, Serra M, Panizza R, Rivara G, Orecchia S, et al. The use of autologous platelet gel to treat difficult-to-heal wounds: A pilot study. Transfusion 2004;44:1013-8.
8Villela DL, Santos VL. Evidence on the use of platelet-rich plasma for diabetic ulcer: A systematic review. Growth Factors 2010;28:111-6.
9Roy S, Driggs J, Elgharably H, Biswas S, Findley M, Khanna S, et al. Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair Regen 2011;19:753-66.
10Knighton DR, Ciresi KF, Fiegel VD, Austin LL, Butler EL. Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF). Ann Surg 1986;204:322-30.
11Singh RP, Marwaha N, Malhotra P, Dash S. Quality assessment of platelet concentrates prepared by platelet rich plasma-platelet concentrate, buffy coat poor-platelet concentrate (BC-PC) and apheresis-PC methods. Asian J Transfus Sci 2009;3:86-94.
12Li H, Hamza T, Tidwell JE, Clovis N, Li B. Unique antimicrobial effects of platelet-rich plasma and its efficacy as a prophylaxis to prevent implant-associated spinal infection. Adv Healthc Mater 2013;2:1277-84.