VENOUS ULCER - SURGICAL DEBRIDEMENT, ANTI BIOTIC-THERAPY AND STIMULATION WITH PLATELET-DERIVED GROWTH-FACTORS

Despite the availability of various topical agents and of new technics for surgical correction, venous stasis ulcers are still characterized by high recurrent rates. Experimental data from wound healing studies demonstrate stimulation of wound healing after topical application of various growth factors (TGF beta, PDGF, EGF). The results of clinical studies suggest that topical use of an autologous platelet releasate (PDWHF) containing various growth factors accelerates healing. In this prospective study the stimulating effect of autologous PDWHF on epith elialization of small ulcers (group A, <5000 mm(2)) and granulation of large ulcers before mesh grafting (>5000 mm(2)) will be demonstrated. Inclusion criteria were the venous aetiology of the ulcer and the fai lure of conventional therapy for 6 month. Exclusion criteria were arte rial occlusive disease, diabetes mellitus, acute wound infection, thro mbocytopenia and pregnancy. There were 24 patients with 36 ulcers, cau sed by postthrombotic syndrome in on-third of cases and in two-thirds by severe in sufficiency of the perforating veins. The ulcer had been present for more than in 10 years in 38% of cases, while there were 6 circumferential ulcers. The overall ulcer healing rate was 77% after a mean of 14 weeks. In group A 78% of the patients were healed after a mean of 16 weeks. In group B the mesh graft procedure was successful i n 90% of the patients after a mean of 13 weeks. Compared with other co nventional therapy studies, we achieved a higher healing rate. PDWHF s eems to create ideal granulation tissue for mesh graft, indicated by a high uptake of the skin grafts. These data should be checked in a ran domized, prospective and placebo-controlled trial.