What are the uses of Platelet-rich Plasma (PRP)?

Uses of Platelet-Rich Plasma (PRP) in Regenerative Medicine

Platelet-rich plasma (PRP) is primarily used in dental/maxillofacial surgery, orthopedics, plastic surgery, and dermatology for its regenerative properties, though evidence supporting its efficacy varies across applications and standardization remains a significant challenge. 1

What is PRP?

• PRP is an autologous or allogeneic blood derivative containing a supraphysiological concentration of platelets (at least 2-3 times above normal levels) 2
• Contains numerous growth factors and cytokines from platelet α-granules that promote tissue healing 1
• Preparation methods vary widely, leading to inconsistent terminology and product characteristics 1

Established Clinical Applications

Dental and Maxillofacial Surgery

• One of the earliest and most established applications of PRP 1
• Used to enhance bone regeneration and wound healing after dental procedures 1
• Promotes tissue repair in poorly vascularized areas 1

Orthopedic and Sports Medicine

• Used for treatment of:
  • Tendon injuries (including Achilles tendon repair) 3
  • Muscle injuries 3
  • Cartilage repair 1
  • Bone healing 1
  • Rotator cuff repair augmentation 3

Dermatology and Aesthetic Medicine

• Applications include:
  • Androgenetic alopecia (hair loss) 4, 5
  • Skin rejuvenation 4
  • Scar revision and acne scars 4
  • Wound healing 5
  • Striae distensae (stretch marks) 4

Plastic Surgery

• Used for tissue regeneration and to enhance graft survival 1
• Promotes angiogenesis and improves healing in poorly vascularized tissues 1

Mechanism of Action

• PRP releases bioactive proteins and growth factors upon platelet activation 1
• These factors promote:
  • Local angiogenesis (formation of new blood vessels) 1
  • Stem cell recruitment 1
  • Cell migration, proliferation, and differentiation 1
  • Deposition of matrix proteins like collagen 1
• Creates a fibrin scaffold that acts as a temporary matrix for tissue repair 1

Preparation Methods

• Requires anticoagulated blood (typically with trisodium citrate, ACD, or CPD) 1
• Common preparation methods include:
  • Gravitational centrifugation techniques 1
  • Standard cell separators 1
  • Autologous selective filtration technology (plateletpheresis) 1
• EDTA is not recommended as an anticoagulant as it causes platelet swelling and activation 1
• Must be activated (via thrombin, re-calcification, etc.) for platelets to release their contents 1

Important Considerations and Limitations

• Significant lack of standardization in preparation methods, resulting in variable product content and efficacy 1
• Limited high-quality randomized controlled trials supporting many applications 1, 2
• Variable terminology complicates interpretation of research (PRP may be called platelet concentrate, platelet-rich fibrin, etc.) 1
• The role of leukocytes and other components in PRP remains unclear 1
• Preparation parameters (centrifugation force, time, activation method) significantly affect final product quality 1

Clinical Evidence Quality

• Most supportive evidence comes from in vitro and in vivo studies rather than large clinical trials 1
• Many studies suffer from imprecision in effect size estimates due to being underpowered 1
• Future clinical trials need better design, standardization of PRP preparation, and disease-specific outcome tools 1

Safety Considerations

• Generally considered safe as it uses autologous material 2
• Proper sterile technique is essential during preparation and application 1
• Commercial PRP preparation devices should be used according to manufacturer specifications 1