PLATELET-RICH FIBRIN: A NEW PARADIGM IN WOUND HEALING
To assess the potential use and benefits of Platelet-Rich Fibrin (PRF) over Platelet-Rich Plasma (PRP), for wound healing post oral and maxillofacial surgeries. This article describes the evolution of this second generation platelet concentrate and its multiple uses in various surgical procedures. Around 5 ml of whole venous blood is collected from the patients in each of the two sterile vacutainer tubes of 6 ml capacity without anticoagulant. The vacutainer tubes are then placed in a centrifugal machine at 3000 revolutions per minute (rpm) for 10 minutes, and the middle fraction containing the fibrin clot is then collected 2 mm below lower dividing line, to obtain the PRF. Cavities filled with PRF post oral and maxillofacial surgical procedures, at the institute, showed faster healing in half the time as compared to physiologic healing. PRF, which belongs to a new second generation of platelet concentrates, with simplified processing, and not requiring biochemical blood handling, has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing. However, the preparation being strictly autologous, the amount of PRF obtained is limited.
2) Gabling VL, Acil Y, Springer IN, Hubert N, Wiltfang J. Platelet-rich plasma and Platelet-rich fibrin in human cell culture. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2009;108:48- 55
3) Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. ThrombHaemost 2004;
4) Gibble JW, Ness PM. Fibrin glue: The perfect operative sealant? Transfusion 1990; 30:741-7.
5) Sunitha R, Munirathnam N. Platelet-rich fibrin: Evolution of a second-generation platelet concentrate. Indian J Dent Res 2008; 19:42-6.
6) Mosesson MW, Siebenlist KR, Meh DA. The structure and biological features of fibrinogen and fibrin. Ann N Y AcadSci 2001; 936:11-30.
7) Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF):A secondgeneration platelet concentrate, Part IV:
Clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101:E56-60.
8) Dvorak HF, Harvey VS, Estrella P, Brown LF, McDonagh J, Dvorak AM. Fibrin containing gels induce angiogenesis. Implications for tumor stroma generation and wound healing. Lab Invest 1987; 57:673-86.
9) Clark RA. Fibrin and wound healing. Ann N Y Acad Sci 2001; 936:355-67.
10) Collen A, Koolwijk P, Kroon M, Van Hinsbergh VW. Influence of fibrin structure on the formation and maintenance of capillary like tubules by human microvascular endothelial cells. Angiogenesis 1998; 2:153-65.
11) Van Hinsbergh VW, Collen A, Koolwijk P. Role of fibrin matrix in angiogenesis. Ann N Y Acad Sci 2001; 936:426-37.
12) Carlson ER. Bone grafting the jaws in the 21 st century: The use of platelet-rich plasma and bone morphogenetic protein. Alpha Omegan 2000; 93:26-30.
13) Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL et al. Platelet-rich fibrin (PRF): A secondgeneration platelet concentrate. Part V: Histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101:299-303.
14) He L, Lin Y, Hu X, Zhang Y, Wu H. A comparative study of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) on the effect of proliferation and differentiation of rat osteoblasts in vitro. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2009; 108:707-13.
15) Uggeri J, Belleti S, Guizzardi S, Poli T, Cantarelli S, Scandroglio R, et al. Dosedependent effects of platelets on activities of human osteoblasts. J Periodontol 2007; 78:1985-91.
16) Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A secondgeneration platelet concentrate, Part III: Leucocytes activation: A new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2006; 101:E51-5.
17) Vinazzer H. Fibrin sealing: Physiologic and biochemical background. Fac Plast Surg 1985; 2:291-5.
18) Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A secondgeneration platelet concentrate, Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2006;101:E45-50.
19) Kawamura M, Urist MR. Human fibrin is a physiologic delivery system for bone morphogenetic protein. ClinOrthopRelat Res 1988; 235:302-10.
20) Pierce GF, Mustoe TA, Altrock BW, Deuel TF, Thomason A. Role of plateletderived growth factor in wound healing. J Cell Biochem 1991; 45:319-26.
21) Bolander ME. Regulation of fracture repair by growth factors. ProcSocExpBiol Med 1992; 200:165-70.
22) Cromack DT, Porras-Reyes B, Mustoe TA. Current concepts in wound healing: Growth factor and macrophage interaction. J Trauma 1990;30:S129-33.
23) Loike JD, Sodeik B, Cao L, Leucona S, Weitz JI, Detemers PA, et al. CD11c/CD18 on neutrophils recognizes a domain at the N Terminus of the A alpha chain of fibrinogen. Proc Natl Acad Sci USA 1991; 88:1044-8.