Zhao W., Katzmarzyk P.T., Horswell R. HbA1c and lower-extremity amputation risk in low-income patients with diabetes. Diabetes Care. 2013; 36:(11)3591-3598

Hemmingsen B., Lund S.S., Gluud C. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2015;

Vayvada H., Demirdover C., Menderes A., Karaca C. Necrotising fasciitis in the central part of the body: diagnosis, management and review of the literature. Int Wound J. 2013; 10:(4)466-472

Aragón-Sánchez J., Quintana-Marrero Y., Lázaro-Martínez J.L. Necrotizing soft-tissue infections in the feet of patients with diabetes: outcome of surgical treatment and factors associated with limb loss and mortality. Int J Low Extrem Wounds. 2009; 8:(3)141-146

Das D.K., Baker M.G., Venugopal K. Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review. BMC Infect Dis. 2012; 12

Fitzgerald R.H., Bharara M., Mills J.L., Armstrong D.G. Use of a Nanoflex powder dressing for wound management following debridement for necrotising fasciitis in the diabetic foot. Int Wound J. 2009; 6:(2)133-139

Sakata J., Sasaki S., Handa K. A retrospective, longitudinal study to evaluate healing lower extremity wounds in patients with diabetes mellitus and ischemia using standard protocols of care and platelet-rich plasma gel in a Japanese wound care program. Ostomy Wound Manage. 2012; 58:(4)36-49

Lee E.Y., Ip W.Y. Necrotizing fasciitis of the extremity caused by Haemophilus influenzae serotype b in a healthy adult. Clin Orthop Relat Res. 2010; 468:(5)1436-1439

Ramanujam C.L., Capobianco C.M., Zgonis T. Using a bilayer matrix wound dressing for closure of complicated diabetic foot wounds. J Wound Care. 2010; 19:(2)56-60

Singer M., Korsh J., Predun W. A novel use of integra™ bilayer matrix wound dressing on a pediatric scalp avulsion: a case report. Eplasty. 2015; 15

Misiakos E.P., Bagias G., Patapis P. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014; 1:(6)

Wukich D.K., Armstrong D.G., Attinger C.E. Inpatient management of diabetic foot disorders: a clinical guide. Diabetes Care. 2013; 36:(9)2862-2871

Alsousou J., Thompson M., Hulley P. The biology of platelet-rich plasma and its application in trauma and orthopedic surgery: a review of the literature. J Bone Joint Surg Br. 2009; 91:(8)987-996

Davis V.L., Abukabda A.B., Radio N.M. Platelet-rich preparations to improve healing. Part I: Workable options for every size practice. J Oral Implantol. 2014; 40:(4)500-510

Schade V.L., Roukis T.S., Haque M. Clostridium septicum Necrotizing Fasciitis of the Forefoot Secondary to Adenocarcinoma of the Colon: Case Report and Review of the Literature. J Foot Ankle Surg. 2010; 49:(2)159e1-e8

Chen L., Wang C., Liu H. Antibacterial effect of autologous platelet-rich gel derived from subjects with diabetic dermal ulcers in vitro. J Diabetes Res. 2013; 2013

Drago L., Bortolin M., Vassena C. Plasma components and platelet activation are essential for the antimicrobial properties of autologous platelet-rich plasma: An in vitro study. PLoS One. 2014; 9:(9)

Serraino G.F., Dominijanni A., Jiritano F. Platelet-rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections. Int Wound J. 2015; 12:(3)260-264

Li G.Y., Yin J.M., Ding H. Efficacy of leukocyte- and platelet-rich plasma gel (L-PRP Gel) in treating osteomyelitis in a rabbit model. J Orthop Res. 2013; 31:(6)949-956

Jia W.T., Zhang C.Q., Wang J.W. The prophylactic effects of platelet-leucocyte gel in osteomyelitis: An experimental study in a rabbit model. J Bone Joint Surg Br. 2010; 92:(2)304-310

Wang H.F., Gao Y.S., Yuan T. Chronic calcaneal osteomyelitis associated with soft tissue defect could be successfully treated with platelet-rich plasma: a case report. Int Wound J. 2013; 10:(1)105-109

Waniczek D., Kozowicz A., Muc-Wierzgon M. Adjunct methods of the standard diabetic foot ulceration therapy. Evid Based Complement Alternat Med. 2013; 2013

Villela D.L., Santos V.L. Evidence on the use of platelet-rich plasma for diabetic ulcer: a systematic review. Growth Factors. 2010; 28:(2)111-116

Isaac A.L., Armstrong D.G. Negative pressure wound therapy and other new therapies for diabetic foot ulceration: the current state of play. Med Clin North Am. 2013; 97:(5)899-909

Armstrong D.G., Lavery L.A. Evidence-based options for off-loading diabetic wounds. Clin Podiatr Med Surg. 1998; 15:(1)95-104

Armstrong D.G., Lavery L.A., Nixon B.P., Boulton A.J. It's not what you put on, but what you take off: techniques for debriding and off-loading the diabetic foot wound. Clin Infect Dis. 2004; 39:S92-99

Platelet-rich plasma, bilayered acellular matrix grafting and negative pressure wound therapy in diabetic foot infection

02 April 2017
Volume 1 · Issue 2


Management and treatment of acute severe diabetic foot disease in patients with suboptimal glycaemic control is a critical issue in wound repair. This paper discusses the clinical efficacy of an aggressive surgical intervention combined with targeted use of regenerative medical therapies in limb preservation. Negative pressure wound therapy (NPWT), platelet-rich plasma (PRP), bilayered acellular matrix grafting and split-thickness skin grafting were combined to treat a patient with diabetes, foot necrotising fasciitis and gaseous gangrene. The wound was completely healed. The clinical outcome revealed that a multi-intervention strategy could be effective for large necrotising fasciitis wounds. Early clinical observation, suggests aggresive surgical intervention preserving intact tissue and targeted use of new regenerative technologies can lead to preservation of a limb.

Patients with diabetes that is under suboptimal control presenting with an infection are at high risk of amputation.1,2 Necrotising fasciitis a rapidly progressive acute diease, often assoicated with diabetes, it is an important cause of morbidity and mortality in these patients with diabetes.3,4 When glycaemic control is poor the rate of amputation and morality in the presence of necrotising fasciitis increases.3,5 Given the potential for amputation along with increased morbidity in patients with comorbidities, different advanced wound-treatment technologies could be useful for healing of challenging soft tissue defects caused by radical debridement of necrotising fasciitis.6 Platelet-rich plasma (PRP) includes a platelet concentration about three to six times above a normal level and a myriad of growth factors and cytokines that, when concentrated, could promote wound healing and tissue regeneration. It may have a promising effect on promotion of both low extremity refractory wound healing,7 as well as in patients following debridement of severely infected wounds.8

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month