Platelet-rich plasma improves esthetic postoperative outcomes of maxillofacial surgical procedures

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Менчишева Y., Мирзакулова U., Юсупова D., Ермуханова G., & Рысбаева Z. (2021). Platelet-rich plasma improves esthetic postoperative outcomes of maxillofacial surgical procedures. in Library, 21(1), 118–126. извлечено от https://inlibrary.uz/index.php/archive/article/view/14535
Ю Менчишева, Казахский национальный медицинский университет им. С. Д. Асфендиярова

Кафедра хирургической стоматологии, Государственная больница №5

У Мирзакулова, Казахский национальный медицинский университет им. С. Д. Асфендиярова

Кафедра хирургической стоматологии, Государственная больница №5

Д Юсупова, Ташкентский государственный стоматологический институт

Кафедра болезней и травматологии челюстно-лицевой области

Г Ермуханова, Казахский национальный медицинский университет им. С. Д. Асфендиярова

Кафедра детской стоматологии

З Рысбаева, Казахский национальный университет им. аль-Фараби

Кафедра клинических дисциплин

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Аннотация

Background: Postoperative facial scars after plastic and reconstructive surgery are visible results that can seriously affect the quality of life of recovering patients. Currently, platelet-rich plasma (PRP) is widely used in medicine to improve tissue regeneration. Purpose: To analyze the esthetic outcomes of using PRP in the late postoperative period of maxillofacial surgical interventions. Material and methods: A total of  100 patients aged 18–60 years who were undergoing plastic and reconstructive surgery in the maxillofacial region were included in this study. The patients were randomly divided in two groups. Fifty patients in the treatment group received PRP injections at the time of surgery. Patients in the control group did not receive any injections. PRP was injected intradermally after suturing the wound. Evaluation of treatment outcomes was carried out by planimetry, the Image J programme during 1 month after surgery and by the Patient and Observer Scar Assessment Scale  30 and 90 days after the surgical procedure. The Dermatological Quality of Life Index was used to assess the negative impact of treatment outcomes on various aspects of the patient’s life. Results: The change of scar width was twice less pronounced in the treatment group. The patients in the treatment group were more satisfied with the results of the treatment and had a higher quality of life. The treatment group exhibited less scaring at all time points than the control group 3 months after surgery. Conclusions: The use of PRP had a pronounced beneficial therapeutic effect in influencing the esthetic outcomes of surgical interventions.

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PLATELET-RICH PLASMA IMPROVES ESTHETIC POSTOPERATIVE OUTCOMES

Acta Chir Plast 2021; 63(3): 118– 126

118

doi: 10.48095/ccachp2021118

Platelet-rich plasma improves esthetic

postoperative outcomes of maxillofacial

surgical procedures

Y. Menchisheva

1

, U. Mirzakulova

1

, D. Usupova

2

, G. Yermukhanova

3

, Z. Rysbayeva

4

1

Department Surgical Dentistry, State Hospital №5, S. D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan

2

Department of the Diseases and Traumatology of the Maxillofacial Region, Tashkent State Dental Institute, Tashkent, Uzbekistan

3

Department of Pediatric Dentistry, S. D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan

4

Department of Clinical Disciplines, Al Farabi Kazakh National University, Almaty, Kazakhstan

Summary

Background:

Postoperative facial scars after plastic and reconstructive surgery are visible results that can seriously affect the quality of life

of recovering patients. Currently, platelet-rich plasma (PRP) is widely used in medicine to improve tissue regeneration.

Purpose:

To analyze

the esthetic outcomes of using PRP in the late postoperative period of maxillofacial surgical interventions.

Material and methods:

A total of

100 patients aged 18–60 years who were undergoing plastic and reconstructive surgery in the maxillofacial region were included in this study.
The patients were randomly divided in two groups. Fifty patients in the treatment group received PRP injections at the time of surgery. Patients
in the control group did not receive any injections. PRP was injected intradermally after suturing the wound. Evaluation of treatment outcomes
was carried out by planimetry, the Image J programme during 1 month after surgery and by the Patient and Observer Scar Assessment Scale
30 and 90 days after the surgical procedure. The Dermatological Quality of Life Index was used to assess the negative impact of treatment
outcomes on various aspects of the patient’s life.

Results:

The change of scar width was twice less pronounced in the treatment group. The

patients in the treatment group were more satisfied with the results of the treatment and had a higher quality of life. The treatment group
exhibited less scaring at all time points than the control group 3 months after surgery.

Conclusions:

The use of PRP had a pronounced beneficial

therapeutic effect in influencing the esthetic outcomes of surgical interventions.

Key words

platelet-rich plasma – scars – quality of life – plastic surgery – outcome measurement

surgery (treatment of disc tissue pathol-
ogy, spinal cord injury) [12,13], ophthal-
mology (treatment of symptomatic dry
eye, corneal ulcers and ocular burns)
[14,15], dentistry and oral surgery (heal-
ing after tooth extraction, treatment
of periodontitis, use in implantology)
[16,17]. PRP is used in dermatology for
purposes including the treatment of ul-
cers, scars, and alopecia [18].

Thus, the clinical use of PRP is treat-

ment of soft tissue injuries, burns and
hard to heal wounds. Also, PRP might be
applied to initiate repair of bone lesion
in case of reduced osteoblasts prolifera-
tion or delayed chondrogenesis [19].

bronectin, increase vascular permeabil-
ity and stimulate angiogenesis [3].

PRP is widely applied in different clin-

ical applications to promote healing of
damaged tissues. Most of the studies
described in the literature are devoted
to the use of PRP in traumatology and
sports medicine (repairing of acute mus-
cle, tendon, ligament, nerve and carti-
lage injury and relieve pain in tendoni-
tis, arthritis, ligament sprains and tear)
[4–7], gynecology (use of PRP in vulvar
lesions, genital prolapse and genital fis-
tulas, in gynesthetics treatment) [8,9],
surgery (healing of acute and chronic
wounds, burns, defects) [10,11], neuro-

Introduction

Platelet-rich plasma (PRP) is the fraction
of plasma containing higher concentra-
tions of platelets compared to whole
blood [1]. The platelets are rich in growth
factors which boosts healing and repair
process [2]. Growth factors contained
in PRP – platelet-derived growth factor
(PDGF), transforming growth factor β
(TGF-β), vascular endothelial growth fac-
tor (VEGF or PDAF), insulin-like growth
factor (IGF) and epidermal growth factor
(EGF) – activate cells migration, stimu-
late fibroblasts, osteoblasts, endothelial
cells and keratinocytes proliferation, en-
hance the production of collagen and fi-

Menchisheva Y., Mirzakulova U., Usupova D., et al. Platelet-rich plasma improves esthetic postoperative outcomes of maxillofacial surgical procedures. Acta Chir Plast.

2021, 63(3): 118–126.

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PLATELET-RICH PLASMA IMPROVES ESTHETIC POSTOPERATIVE OUTCOMES

Acta Chir Plast 2021; 63(3): 118– 126

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purposes. This randomized controlled
trial was based on the revised CONSORT
statement [35]. The study is pre-regis-
tered in clinical trials registry.

The inclusion criteria were for patients

undergoing plastic and reconstructive
operation in the maxillofacial area with
high risk for scaring. Exclusion criteria
were used for patients with platelet dys-
function syndrome, haemodynamic in-
stability, local infection at the site of the
procedure, systemic use of corticoster-
oids within 2 weeks, recent fever, and
cancer. To identify patients considered
to be at high risk for scaring, we used re-
gression analysis of the results of clin-
ical and laboratory research methods.
By the stepwise logistic regression, we
identified factors that significantly in-
crease the risk for scaring after surgical
procedures (Tab. 2). All factors were ob-
tained during the study of archival mate-
rial of medical cases of the patients (with
and without excessive scaring) who had
plastic and reconstructive procedures.

The resulting logistic regression equa-

tion for predicting the risk for scar-
ing in the postoperative period is the
following:

P =

1

1 + e

–d

where d is the value of the discriminant
function: d= 2.033 + 1.531× hyperten-
sion, ischemic heart disease + 1.051×

and that a period of 6–18 months is re-
quired for scar maturation [31,32]. Heal-
ing and remodeling are largely complete
by 8–12 months [33], and the evalua-
tion of the scars might be delayed until
1-year post-surgery [34]. Therefore, to
draw an appropriate conclusion, obser-
vation time is critical.

Study hypothesis: esthetic outcomes

and the quality of life are better in pa-
tients whose surgical incision was in-
jected with PRP.

Material and methods

Patients

One hundred hospital patients aged
18–60 years (City Hospital 5, Almaty, Ka-
zakhstan) who were undergoing plastic
and reconstructive surgery in the max-
illofacial region and were considered to
be at high risk for scaring were included
in this randomized controlled trial. Pa-
tients were randomly allocated into
two groups. Fifty patients (26 males and
24 females aged 43 ± 6 (21–60) years)
in the treatment group received PRP in-
jections at the time of surgery, whereas
50  patients (27 females and 23 males
aged 41 ± 5 (19–60) years) in the control
group did not receive any injections. The
patients underwent the following soft
tissue procedures (Tab. 1).

All enrolled patients signed informed

consent forms to be eligible for research

According to the results of conducted

studies [1–19] of the use of PRP in sur-
gery and other specialties of medicine,
the application of autologous platelet-
rich plasma is indicated for the induction
of normal wound healing, for promoting
the healing of hard to heal or non-heal-
ing wounds, ulcers and burns.

Due to the widespread use of PRP in

esthetic medicine, plastic surgery and
dermatology, it is reasonable to be-
lieve that the use of PRP is also indi-
cated for improving the results of surgi-
cal treatment.

After plastic and reconstructive sur-

gery, postoperative facial scars have
a substantial impact on the quality of life
through psychological distress and de-
pression, which affects patients’ working
capacity and social adaptation [20,21].

Platelet-rich plasma (PRP) releases nu-

merous growth factors that may be in-
valuable in treatment [22,23]. The effects
of growth factors may be beneficial as
a therapy for wounds with delayed heal-
ing [24,25]. Complications in the early
postoperative period, such as suppura-
tion of the wound, divergence of sutures
and delayed healing of patients with co-
morbid conditions often lead to adverse
outcomes with scarring in the late post-
operative period. Previous studies have
assessed the efficiency of PRP in wound
healing [26,27] although few of them
provide an assessment of the influence
on the skin or shed light on patient sat-
isfaction. To evaluate esthetic outcomes,
there is a tendency for physicians to use
questionnaires [28–30]. In some studies,
outcomes are presented with the use of
pictures but without objective analysis
of quantitative data, or samples are pre-
sented too indistinctly to be verifiable
and trustworthy. The aim of this study
was to evaluate surgical outcomes and
esthetic effects in patients after plastic
and reconstructive surgery in the max-
illofacial area.

Wound healing studies have dem-

onstrated that scars usually develop
6–8  weeks following re-epithelization,

Tab. 1. Distribution of patients with postoperative wounds of soft tissues of the
maxillofacial region after reconstructive plastic and esthetic operations (N = 100)
depending on the type of the operation performed.

Control group (N = 50)

Treatment group (N = 50)

number of

patients

%

number of

patients

%

flap surgery

30

60

31

62

scar revision surgery

12

24

13

26

secondary

cheilorhinoplasty

6

12

4

8

facelift

1

2

1

2

lipofilling

1

2

1

2

total

50

100

50

100

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ing plasma was applied to a  sterile
gauze and put over the postoperative
wound.

were performed with a  syringe using
a  30G needle. The distance between
injections was 1.5–2 cm. The remain-

diabetes + 0.239 × the volume of the op-
eration + 0.878 × multiplicity of previous
operations – 0.129 × excess of subcuta-
neous fat – 0,045 × age – 0.021× blood
coagulability – 0.018 × gender – 0.014 ×
the absolute number of platelets in the
blood.

If the P-value is < 0.5, then it can be

assumed that the "event" (the devel-
opment for scaring) will not occur; oth-
erwise, an increased risk for scaring is
assumed.

To assess the effectiveness of the

method for predicting the development
of high risk for scaring, the receiver op-
erating characteristic (ROC) analysis
was performed with the construction of
a ROC curve. The value of the area under
the ROC-curve was 0.98 (95% confi-
dence interval), which indicates the in-
formativeness of the proposed forecast-
ing method based on logistic regression
(Graph 1).

PRP preparation and method of
injection

All patients in the treatment group re-
ceived PRP during their surgical op-
erations to improve the healing of
postoperative soft tissue wounds in
the maxillofacial area. Vacuum tubes
(9–27 mL) were used for venous blood
sampling. On average, one tube of 9 mL
was required for wounds < 10 cm in
length, two tubes for 10–20 cm wounds,
and three tubes for large wounds
(> 20 cm). The tubes filled with venous
blood were centrifuged for 5 minutes at
3,000 rpm. Thereafter, two fractions of
blood samples were visible in the tubes:
an erythrocyte-leukocyte clot, and
a layer of plasma enhanced with plate-
lets. The lower third of the plasma layer
contained 600,000 platelets, the middle
of the layer 200,000 platelets, and the
top of the layer 50,000 platelets per 1 μL.
A  syringe was used to take the lower
third of the plasma layer, which was in-
jected intradermally, 0.5 cm from the
edge of the wound after suturing. Injec-
tions of autologous plasma (0.1–0.2 mL)

Tab. 2. Coefficients of the discriminant function of factors contributing to the
development of scaring in patients after plastic and reconstructive surgery.

No. Factors contributing to the development of scaring

Discriminant

function

coefficients

1

hypertension, ischemic heart disease

1.531

2

diabetes

1.051

3

multiplicity of previous operations (at the same area)

0.878

4

volume of the operation (duration of the operation

> 2 hours, the length of the incision > 10 cm)

0.252

5

excess of subcutaneous fat

−0.129

6

age (> 35 years)

−0.045

7

blood coagulability

−0.021

8

gender (women)

0.018

9

absolute number of platelets in the blood

−0.014

10

constant (a)

2.033

Graph 1. Receiver operating characteristic curve.

0.0

0.0

0.2

0.4

0.6

0.8

1.0

0.2

0.4

0.6

0.8

1.0

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Results

Scars planimetry

Fifty patients in the treatment group and
50 patients in the control group under-
went planimetry using a micrometer to
determine the width and expansion of
postoperative scars. There were no sta-
tistically significant differences in the
width of postoperative wounds in the
first day after the operation.

The median of postoperative wounds

width in the control group was 2.0 mm

25

= 1.0; Р

75

= 3.0) which is greater

Smirnov method. The variables between
two groups were compared by the Mann–
Whitney U test as the resultant distribu-
tion of parameters in two groups was
not normal. The statistical data were pre-
sented as the mean with the standard
error (SE) and the median with 25–75%
limits. The difference of parameters with
P value < 0.05 was set as statistically signif-
icant. The statistical analysis is performed
in consultation with a certified biostatisti-
cian from the Department of Biostatistics
(S. D. Asfendiyarov KazNMU, Almaty)

The treatment of patients in the con-

trol group was identical to that of pa-
tients in the treatment group in the
postoperative period and included the
following: daily dressings with antiseptic
solutions, antibacterial therapy and ad-
ministration of analgesics.

Evaluation methods

All patients in the treatment and control
groups underwent planimetry to deter-
mine the width of postoperative scars 1,
3, 5, 7, 10, 30 and 90 days after surgery
using a  micrometer and Image J pro-
gram. To record the width of wounds,
photographs were taken using a Nikon
camera (D5100, 50 mm lens).

The assessment of postoperative scars

was carried out after 30 and 90 days by
conducting a  questionnaire that used
the Patient and Observer Scar Assess-
ment Scale (POSAS) with all patients and
doctors. The POSAS questionnaire has
6 indicators using a 1–10 scoring scale,
with 1 being normal skin and 10 being
the least normal skin possible.

The Dermatological Quality of Life

Index (DQLI) was used to determine and
assess the negative impact of the re-
sults of treatment on various aspects of
patients’ lives 30 and 90 days after sur-
gery. DQLI has 10 questions, with up to
3 points for each question, thus allowing
a minimum of 0 points and a maximum
of 30 points. A higher score indicates the
postoperative scars had a greater nega-
tive impact on the patient’s quality of life.

The results of histological and ultra-

sound examination, determination of in-
terleukins in the postoperative wound
were published earlier. This study is
aimed only at assessing the esthetic com-
ponent of the results of the use of PRP.

Statistical analysis

The statistical analysis was performed
using the SPSS software package (IBM
Corp., Released 2012, IBM SPSS Statis-
tics for Windows, Version 21.0, Armonk,
NY). The distribution of the parame-
ters was tested using the Kolmogorov–

Fig. 1. Appearance of scars in patients of the control group on day 10 after

surgery.

Fig. 2. Appearance of scars in patients of the control group on day 30 after

surgery.

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Me = 80.1 pixels (P

25

= 47.0; P

75

= 113.4)

which is less than the median of the scar
width in patients of the control group
Me = 99.3 pixels (P

25

= 71.1; P

75

= 130.4),

P < 0.05 (Graph 3).

Evaluation of scars

POSAS observer scale

We used the POSAS questionnaire
30 and 90 days after surgery to evaluate
the quality of postoperative scars. The
POSAS questionnaire (observer part) in-
cludes six indicators (vascularity, pig-
mentation, thickness, relief, pliability,
surface area) which were assessed by
physicians using a 1–10 scoring scale.

Thirty days after surgery, the mean

score value of all six indicators of the
scale was 5.8 ± 0.14 in the control group,
which was about 2.3× greater than the
treatment group mean. The mean value
in the treatment group was 2.5 ± 0.14
(P < 0.05). Ninety days after surgery, the
mean score value of the control group
was 3.7 ± 0.23 and the mean value in the
treatment group was 1.6 ± 0.07 (P < 0.05)
(Tab. 3).

POSAS patient scale

The POSAS questionnaire (patient part)
included six questions which were as-
sessed by patients using a 1–10 scoring
scale.

Thirty days after surgery, the mean pa-

tient POSAS score of the control group
was 5.0 ± 0.75, which was about 1.9times
greater than the treatment group mean.
The mean value in the treatment group
was 2.7 ± 0.35 (P < 0.05).

1.0 mm (Р

25

 = 1.0; Р

75

= 2.5) and 2.0 mm

25

 = 1.0; Р

75

= 3.0) in the treatment and

control groups, respectively (P < 0.05).
On the 30

th

day, this indicator was

3.0 mm (Р

25

 = 2.0; Р

75

= 4.0) in the control

group, which is greater than the median
value of the treatment group – 1.5 mm

25

 = 1.0; Р

75

 = 3.5) (Graph 2).

Using the Image J program, we meas-

ured the width of the scars in pix-
els on the 10

th

and 30

th

days. The me-

dian widths of the postoperative scar
were 57.6 pixels (P

25

= 44.0; P

75

= 92.7)

and 62.8 pixels (P

25

= 46.7; P

75

= 120.1)

in the treatment and control groups
on 10

th

day after surgery, respectively

(P < 0.05). One month after the surgical
procedure, the postoperative scar width
in patients of the treatment group was

than the median width in the treatment
group 1.0 mm (Р

25

= 1.0; Р

75

= 1.5) on

3.5 days after surgery (P < 0.05). On the
7

th

day after surgical procedure, the me-

dian widths of postoperative wounds
were 2.0 mm (Р

25

= 1.0; Р

75

= 3.0) and

1,0 mm (Р

25

= 1.0; Р

75

= 2.0) in the con-

trol and treatment groups, respectively
(P < 0.05).

The most noticeable changes were

on the 10

th

and 30

th

days after opera-

tion. The scars of the patients in the
control group (Fig. 1, 2) were distin-
guishable from the normal surround-
ing skin on the 10

th

and 30

th

days after

operation as opposed to the treatment
group patients (Fig. 3, 4), who received
PRP injections. So, on the 10

th

day after

surgery, the median scar widths were

Fig. 4. Appearance of scars in patients

of the treatment group on day 30

after surgery.

Fig. 3. Appearance of scars in patients

of the treatment group on day 10

after surgery.

Graph 2. The expansion of postoperative scars (mm) at: A) 3 days; B) 5 days; C) 7 days; D) 10 days; E) 30 days after surgery.

0

1

2

3

4

5

6

7

8

9

A)

treatment group

0

1

2

3

4

5

6

7

8

9

B)

0

1

2

3

4

5

6

7

8

9

C)

0

1

2

3

4

5

6

7

8

9

D)

control group

0

1

2

3

4

5

6

7

8

9

E)

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Acta Chir Plast 2021; 63(3): 118– 126

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terpretation in the control group, the
treatment results had a  slightly nega-
tive effect, while in the treatment group,
they did not have a negative effect. The
differences between the mean values of
DQLI on the 30

th

and 90

th

days after sur-

gery in the two groups are displayed in
Graph 4.

Discussion

The main results of the study are the
2-fold reduction of the scar width on
the 90

th

day after surgery and higher

patient satisfaction obtained from
questionnaires.

There is a number of studies offering

different speed and time of centrifuga-
tion to obtain PRP. The methods of prep-
aration of PRP are different in many ways
[36–39], which explains the lack of stand-
ardized methods of obtainment and ap-
plication of PRP. The therapeutic effect
of PRP could be achieved by increas-
ing the concentration of platelets twice
[40]. We were guided by the method of
Akhmerov et al [41] in choosing the time
and speed of rotation to PRP (specifically
5 min at a speed of 3,000 rpm). Regard-
ing the choice of the frequency of in-

prox. 4times more than in the treatment
group, i.e. 3.1 ± 4.25 (P < 0.05). Accord-
ing to the interpretation of DQLI in the
control group, the postoperative out-
comes of maxillofacial surgical proce-
dures had a strong negative impact on
the patients’ lives, while in the treatment
group, these outcomes had a  slight
negative impact. Ninety days after sur-
gery, the mean values of scores were
4.3 ± 2.91 and 1.7 ± 1.82 points in the
control and treatment groups, respec-
tively (P < 0.05). According to the in-

Ninety days after surgery, the mean

score value of the control group was
2.7 ± 0.48, which was about 1.8times
more than the treatment group mean.
The mean value in the treatment group
was 1.5 ± 0.14 (P < 0.05). The differences
between the mean values in the two
groups are displayed in Tab. 4.

Results of the DQLI

Thirty days after surgical procedures,
the mean score value in the control
group was 12.7 ± 6.7, which was ap-

Graph 3. The expansion of postoperative scars (pixels) at: A) 10 and B) 30 days

after surgery.

treatment group

control group

0

50

100

150

200

250

300

350

400

A)

0

50

100

150

200

250

300

350

400

B)

Tab. 3. The mean observer POSAS scores in the control ad treatment groups 30 and 90 days after surgical procedures.

N Indicators

30 days after surgery

90 days after surgery

control group

N = 50

treatment group

N = 50

P-value

control group

N = 50

treatment group

N = 50

P-value

mean ± SE median

25

–Р

75

) mean ± SE

median

25

–Р

75

)

mean ± SE median

25

–Р

75

) mean ± SE

median

25

–Р

75

)

1. vascularity

5.6 ± 0.14

7.0

(6.0–7.0) 2.2 ± 0.14

2.0

(1.75–3.0) Р < 0.05 3.0 ± 0.14

3.0

(2.0–4.0) 1.6 ± 0.18

1.0

(1.0–2.0)

Р < 0.05

2. pigmentation 6.4 ± 0.16

7.0

(6.0–7.0) 3.1 ± 0.1

3.0

(2.0–4.0) Р < 0.05 3.8 ± 0.12

4.0

(3.0–4.0) 1.8 ± 0.13

2.0

(1.0–2.0)

Р < 0.05

3. thickness

5.8 ± 0.16

7.0

(6.0–7.25) 2.2 ± 0.14

2.0

(1.75–3.0) Р < 0.05 4.6 ± 0.15

5.0

(4.0–5.0) 1.7 ± 0.18

2.0

(1.0–2.0)

Р < 0.05

4. relief

6.0 ± 0.16

6.5

(6.0–7.0) 2.3 ± 0.13

2.0

(2.0–3.0) Р < 0.05 3.2 ± 0.19

4.0

(3.0–4.0) 1.7 ± 0.16

2.0

(1.0–2.0)

Р < 0.05

5. pliability

6.1 ± 0.16

6.0

(5.75–7.0) 2.5 ± 0.13

2.0

(1.0–2.0) Р < 0.05 4.0 ± 0.16

4.0

(3.0–5.0) 1.6 ± 0.17

2.0

(1.0–2.0)

Р < 0.05

6. surface area

5.4 ± 0.16

6.0

(5.75–7.0) 2.6 ± 0.11

1.5

(1.0–2.0) Р < 0.05 3.6 ± 0.17

4.0

(3.0–5.0) 1.3 ± 0.14

1.0

(1.0–2.0)

Р < 0.05

POSAS – patient and observer scar assessment scale

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PLATELET-RICH PLASMA IMPROVES ESTHETIC POSTOPERATIVE OUTCOMES

Acta Chir Plast 2021; 63(3): 118– 126

124

jection of PRP several studies reported
about multiplicity of PRP application
[43–45] or injection [46] during or after
surgery.

We used a  single plasma injection,

since we believe that a single plasma in-
jection as a stimulator of regeneration is
sufficient to start the process of normal
wound healing. A  single PRP injection
has also been suggested in the studies
of Eichler et al [47].

Considering the anatomical features

of blood supply and innervation on

Graph 4. The mean values of the dermatological quality of life index in patients

of the control and the treatment groups at 1 and 3 months after surgical

procedures.

0

5

10

15

20

25

1 month

3 months

treatment group

control group

Tab. 4. The mean patient POSAS scores in the control and treatment groups 30 and 90 days after surgical procedures.

N Indicators

30 days after surgery

90 days after surgery

control group

N = 50

treatment group

N = 50

P-value

control group

N = 50

treatment group

N = 50

P-value

mean ± SE median

25

–Р

75

) mean ± SE

median

25

–Р

75

)

mean ± SE median

25

–Р

75

) mean ± SE

median

25

–Р

75

)

1.

Has the scar

been painful

the past few

weeks?

2.9 ± 0.13

3.0

(2.0–3.25)

1.4 ± 0.07

1.0

(1.0–2.0)

Р < 0.05 1.1 ± 0.05

1.0

(1.0–1.0)

1.0 ± 0.02

1.0

(1.0–1.0)

Р < 0.05

2.

Has the scar

been itching

the past few

weeks?

2.5 ± 0.27

3.0

(2.0–4.0)

1.9 ± 0.18

2.0

(1.0–2.0)

Р < 0.05 1.3 ± 0.07

1.0

(1.0–2.0)

1.3 ± 0.07

1.0

(1.0–2.0)

Р < 0.05

3.

Is the scar

color differ-

ent from the

color of your

normal skin

at present?

6.6 ± 0.23

5.0

(3.0–8.0)

3.3 ± 0.14

2.0

(2.0–3.0)

Р < 0.05 3.2 ± 0.14

3.0

(2.0–4.0)

1.9 ± 0.14

2.0

(2.0–3.0)

Р < 0.05

4.

Is the stiff-

ness of the

scar differ-

ent from your

normal skin

at present?

6.0 ± 0.27

6.0

(2.0–8.25)

2.9 ± 0.21

1.0

(1.0–2.25)

Р < 0.05 3.2 ± 1.33

3.0

(2.0–4.0)

1.7 ± 0.14

1.0

(1.0–2.25)

Р < 0.05

5.

Is the thick-

ness of the

scar differ-

ent from your

normal skin

at present?

6.6 ± 0.21

6.0

(2.0–7.75)

3.5 ± 0.25

2.0

(1.0–3.25)

Р < 0.05 3.7 ± 1.43

4.0

(3.0–5.0)

1.8 ± 0.15

2.0

(1.0–3.25)

Р < 0.05

6.

Is the scar

more irregu-

lar than your

normal skin

at present?

5.7 ± 0.31

5.0

(2.0–6.0)

3.4 ± 0.23

2.0

(1.0–2.25)

Р < 0.05 3.7 ± 1.51

4.0

(2.75–5.0)

1.7 ± 0.12

2.0

(1.0–2.25)

Р < 0.05

POSAS – patient and observer scar assessment scale

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PLATELET-RICH PLASMA IMPROVES ESTHETIC POSTOPERATIVE OUTCOMES

Acta Chir Plast 2021; 63(3): 118– 126

125

study more objective than those con-
ducted previously.

Conclusion

The current study demonstrates two
findings: the first was that the use of PRP
improves postoperative wound healing
and results in better esthetic outcomes
in the postoperative period; the second
finding was that the patient satisfaction
with the results and quality of life was
higher in the treatment group where
PRP was used.

Role of authors:

Yuliya Menchisheva: originate con-

cept and design of the study, operation of the patients,
measurement of the scars, PRP preparation, acqui-
sition, analysis and interpretation of the data, critical
revision of the manuscript, crafting of the manuscript.

Ulmeken Mirzakulova:

operation of the patients,

analysis and interpretation of the data, crafting of the
manuscript, statistical analysis.

Dildora Usupova:

operation of the patients, measure-

ment of scars of patients, data analysis.

Gulzhan Yermukhanova:

review of the literature,

critical revision of the manuscript, crafting of the
manuscript.

Zhanagul Rysbayeva:

review of the literature, crafting

of the manuscript, statistical analysis.

Ethical considerations:

All participating patients sig-

ned informed consent forms to be eligible for research.
Ethics approval was obtained from the local ethics Co-
mmittee. The study protocol conformed to the ethical
guidelines of the 1975 Declaration of Helsinki.

Conflict of interest:

We are declaring that no com-

peting interests exist. We declare that we received no
financial support for the research, authorship or publi-
cation of this article.

References

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Borrione P., Gianfrancesco AD., Pereira MT.,

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Am J Phys Med Rehabil.

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Chicharro-Alcántara D., Rubio-Zaragoza M.,

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Hall MP., Band PA., Meislin RT., et al. Platelet-

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spective on their scarring is ultimately
the most important in relation to pa-
tients’ quality of life.

Many studies evaluate the use of PRP

in combination with other treatment
methods. These studies have had very
similar designs, often being presented
in a couple of groups, where researchers
compare results of treatment methods,
one of which includes the use of PRP.
Majani et al write about the treatment of
patients with traumatic scars [49]. In this
study which used a  small sample size,
and the Manchester Scar Scale, it was
found that PRP was associated with bet-
ter treatment results.

It was our aim to find studies not lim-

ited to only facial surgeries or dermatol-
ogy, where authors describe the esthetic
results after surgeries. The most exten-
sive study in our search was made by
Balbo et al, where a five-year analysis of
the results of 115 patients with the am-
putations or wounds of fingers treated
with platelet gel was presented [50]. The
difference of this study from the study
conducted at our hospital is the applica-
tion of the platelet rich gel, not the in-
jection of PRP directly into the soft tis-
sues as it was done in our case. Balbo et
al reported that the recovery of soft tis-
sues of all patients ranged from 80 to
100% (median time 3 weeks) and the es-
thetic results were satisfactory in nearly
all cases that were shown in numerous
photos after surgeries. According to the
article, patients who have undergone
surgeries were satisfied with the results
of the treatment afterwards, but these
claims were not supported by objective
quantitative data.

None of the studies found in the liter-

ature were directly comparable to our
study in terms of design or methodol-
ogy. However, all studies found simi-
lar results. A strength of our study was
that we measured outcomes from dif-
ferent perspectives (both that of the pa-
tient and the surgeon) and triangulated
results from different methods of meas-
urement. We feel that this makes our

the face and neck, we propose to in-
ject PRP leaving 0.5 cm from the edge
of the wound. We were guided by the
regulation of the Republic of Kazakh-
stan (No. 666, November, 2009) on the
procurement and processing of blood
components, choosing the amount of
blood taken from the patient. According
to the recommendations of Akhmerov
et al [41], in the treatment of various dis-
eases (in such fields of medicine as sur-
gery, traumatology, gynecology), it is
necessary to inject 3–9 mL of PRP, de-
pending on the clinical case. A total of
9 mL of blood was required to obtain
3 mL of PRP. In current study, one tube of
9 mL was required for wounds < 10 cm
in length (3 mL of PRP), two tubes for
10–20 cm wounds (6 mL of PRP), and
three tubes for wounds > 20 cm (9 mL
of PRP).

The goal of PRP is to minimize wound

complications and attain better esthetic
outcomes. Previous studies have shown
the efficiency of PRP in different wound
healing processes, but few have pro-
vided an assessment of the influence of
PRP on skin quality or assessed patient
satisfaction with treatment results.

Several studies have evaluated the po-

tential of platelet rich plasma to treat
scar tissues. Willemsen et al reported
that platelet rich plasma reduced re-
covery time and improved esthetic out-
comes in facial rejuvenation [48]. They
observed when the patients could re-
turn to work or restart their social activi-
ties after surgery. The authors conducted
questionnaires about the appearance
of 82 patients’ faces after 4 weeks. They
used three questions with a scale 1–10
and surveyed only surgeons. Although
they used a different scale than the one
used in our study, the results were simi-
lar: both studies found that scarring was
less pronounced in the treatment group
relative to the control group. Our study
also surveyed patients. We consider this
a strength of our study because a sur-
geon’s  perspective alone may not be
objective, and because the patient per-

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PLATELET-RICH PLASMA IMPROVES ESTHETIC POSTOPERATIVE OUTCOMES

Acta Chir Plast 2021; 63(3): 118– 126

126

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Yuliya Menchisheva, MD, PhD

S. D. Asfendiyarov Kazakh National

Medical University

Tole bi 94

Almaty, 050000

Kazakhstan

e-mail: menchisheva.y@kaznmu.kz

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proLékaře.cz | 22.2.2022 | login: menchisheva.y@kaznmu.kz

Библиографические ссылки

Borrione P., Gianfrancesco AD., Pereira MT., et al. Platelet-rich plasma in muscle healing. Am J Phys Med Rehabil. 2010,89(10): 854-861.

Chicharro-Alcantara D., Rubio-Zaragoza M., Damia-Gimenez E., et al. Platelet rich plasma: new insights for cutaneous wound healing management. J Funct Biomater. 2018,9(1): 10.

Sclafani AP., Azzi J. Platelet preparations for use in facial rejuvenation and wound healing: a critical review of current literature. Aesth Plast Surg. 2015; 39(4): 495-505.

Hall MP., Band PA., Meislin RT., et al. Platelet--rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009, 17(10): 602-608.

Li X., Xu G, Hou YL., et al. Are Platelet concentrates an ideal biomaterial for arthroscopic rotator cuff repair? A meta-analysis of randomized controlled trials. Arthroscopy 2014, 30(11): 1483-1490.

Sanchez M., Delgado D., Sranchez P., et al. Platelet rich plasma and knee surgery. Biomed Res I nt. 2014, 2014:890630.

Creaney L., Hamilton B. Growth factor delivery methods in the management of sports injuries: the state of play. Br J Sports Med. 2008, 42(5): 314-320.

Dawood AS., Salem HA. Current clinical applications of platelet-rich plasma in various gynecological disorders: An appraisal of theory and practice. Clin Exp Reprod Med. 2018,45(2): 67-74.

Galal M., Khalifa A., Abd El Hafez M., et al. Platelet-rich plasma (PRP) in obstetrics and gynecology. Egypt J Hosp Med. 2021,83(1): 889-894.

de Vos RJ., van Veldhoven PL., Moen MH., et al. Autologous growth factor injections in chronic tendinopathy: a systematic review. Br Med Bull. 2010,95:63-77.

Ahmed M., Reffat SA., Hassan A., et al. Platelet-rich plasma for the treatment of clean diabetic foot ulcers. Ann Vase Surg. 2017, 38: 206-211.

Ji-Jun H., Hui-Hui S., Qing L., et al. Efficacy of using platelet-rich plasma in spinal fusion surgery-a preferred reporting items for systematic reviews and meta-analyses-compli-ant meta-analysis. World Neurosurg. 2020, 139: e517-e525.

Kaplan N. A study of platelet rich plasma commonly used in neurosurgery practice. Merit ResJMedSci. 2019, 7(1): 1-7.

Ronci G, Ferraro AS., Lanti A., et al. Platelet--rich plasma as treatment for persistent ocular epithelial defects. TransfusApherSci. 2015; 52(3): 300-304.

Alio JL., Arnalich-Montiel F., Rodriguez AE. The role of "eye platelet rich plasma" (E-PRP) for wound healing in ophthalmology. Curr Pharm Biotechnol. 2012,13(7): 1257-1265.

Albanese A., Licata ME., Polizzi B., et al. Platelet-rich plasma (PRP) in dental and oral surgery: from the wound healing to bone regeneration. Immun Ageing. 2013, 10(1): 23.17. Carlson NE., Roach RB. Jr. Platelet-rich plasma: clinical applications in dentistry. J Am Dent Assoc. 2002, 133(10): 1383-1386.

Khatu SS., More YE., Gokhale NR., et al. Platelet-rich plasma in androgenic alopecia: myth or an effective tool. J Cutan Aesthet Surg. 2014, 7(2): 107-110.

Oryan A., Alidadi S., Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther. 2016,16(2): 213-232.

De Sousa A. Psychological issues in oral and maxillofacial reconstructive surgery. Br J Oral MaxillofacSurg. 2008,46(8): 661 -664.

De Sousa A. Psychological issues in acquired facial trauma. Indian J Plast Surg. 2010,43(2): 200-205.

Gasparyan AY., Ayvazyan L., Pretorius E., et al. Platelets in rheumatic diseases: friend or foe? CurrPharm Des. 2014,20(4): 552-566.

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