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PRP has shown great promise clinically and histologically, especially for healing soft tissue in a standard wound of a donor site for a split-thickness skin graft.^101,102 Additionally, healing therapies for burns may benefit significantly from PRP application. The platelets release growth factors and cell-signaling cytokines, such as interleukin and interferon, that act to regulate inflammation and infection in the immune system¹⁰³ (Fig 1-11).

When compared to non-PRP–assisted clotting, PRP-assisted clotting is remarkable for its rapidity of healing in the basal cells at the edge of the wound, where EGF induces epithelial proliferation; subsequent migration to the granulation tissue helps the clot’s cell adhesion molecules. Unlike an unassisted clot, the PRP clot reveals the bundles of fibroblasts and collagen, evidence of an expanding epithelium, and more mature healing. This comparatively accelerated maturity is also evidenced by increasingly reduced vascularity and fibroblastic cellularity over time, as well as quicker fleshlike appearance in 2 to 6 months. Reduced pain in the first 7 days of the wound, and reduced scarring over time, are also notable differences effected by the PRP clot. These benefits are also demonstrated in healing of other soft tissue wounds, including mucosal flaps, dermal fat grafts, and similar wounds.¹

Bone and soft tissue healing can be strengthened in a variety of surgical procedures when a concentrated mixture of autologous platelets is placed at the wound site. The relative ease of methods for obtaining PRP makes it an attractive regenerative adjunct therapy for many surgical treatments. Promoters of PRP tout its ability not only to help restore damaged bone and soft tissue but also to enhance wound healing, lower the patient’s pain and discomfort after the surgical procedure, and reduce the rates of infection and loss of blood.^104–106 Much of the recent literature on PRP has been devoted to its wide range of applications in tissue healing and repair, including maxillofacial, periodontal, oral (Fig 1-12), and plastic surgery; heart and spine surgery; and chronic ulcers of the skin and soft tissue.^107–110 Some studies have suggested that in addition to enhancing wound healing, PRP provides antimicrobial qualities to inhibit postoperative infections in oral surgery.¹¹¹ PRP has been used in such soft tissue therapies as ligament, muscle, and tendon repair^38,112; rotator cuff tears^113–115; skin ulcers^116,117; acne scarring¹¹⁸; and limb amputation.^119–121

FIG 1-12 Application of PRP in a sinus elevation procedure. (a) Once an adequate volume of graft material hydrated with PRP liquid has been placed, the window is ready for a PRP membrane. (b) The PRP membrane is placed over the lateral window, and then the flap is sutured back in place.