Questionable efficacy of autologous platelet growth factors (PDHWF) in thetreatment of venous leg ulcers

Chronic venous insufficiency (CVI) can cause ulcers of the lower limb havin g the character of a full thickness wound involving the subcutaneous tissue s and fat. Healing requires wound contraction, connective tissue formation and finaly reepithelialisation. To induce wound heating, on an underlying d isturbed environment due to longterm effects of CVI, artificial stimuli may be needed. In a placebo controlled study we tried topical application of a utologous PDWHF (platelet derived wound healing factors), to achieve ulcer healing and improve the microangiopathy surrounding of the ulcer area, as t here are decreased number of skin capillaries and reduction in cutaneous va scular reserve. Alterations of cutaneous circulation during the course of t he study were documented by capillaroscopy, transcutaneous oxygen pressure and laser Doppler flux (IDF) measurements. We were able to recruite 15 pati ents all suffering from chronic nonhealing venous stasis ulcers. Eleven of the 15 patients agreed to participate in a placebo-controlled double blind study,whereas 4 patients agreed to participate only if they would be treate d with PDWHF. The median age and duration of ulceration of the 6 patients ( 3 male/3 female) treated with placebo were 71 years and 1089 days. The medi an age and duration of ulceration of the 9 patients (1 male/8 females) trea ted with PDWHF were 66 years and 732 days. Duration of therapy for the PDWH F group was 91 days, as compared to 154 days for the placebo group. Despite 2 completely healed ulcers, the expensive treatment did not reveal any sig nificant clinical advantage. In den PDWHF group an ulcer area of 26.9 cm(2) was measured at the beginning, of 26.2 cm(2) at the end; in the placebo gr oup, 34.7 cm(2) and 35.5 cm(2). The nonsignificant increase of the capillar y density at the ulcer border in the active group as well as the increase i n the tcPO(2) in contrast to little change in both parameters in the placeb o group, suggests neoangiogenic abilities to PDWHF,secondarily leading to a better blood distribution with higher oxygen tension.