Role of platelet-derived growth factor as an adjunct to surgery in the management of pressure ulcers

Management options for pressure ulcers include local wound care, surgical r epair, and, more recently, topical application of platelet-derived growth f actor (PDGF). PDGF is a glycoprotein that is mitogenic for mesenchymal cell s and has been studied extensively for applicability in promoting the heali ng of chronic human wounds. Using data obtained from a multicenter clinical trial for the treatment of full-thickness pressure ulcers, a subset analys is was performed to investigate the outcome of salvage surgery for pressure ulcers, after incomplete closure occurred with the topical use of either r ecombinant human PDGF-BB (rhPDGF-BB) or placebo gel. At the University of Michigan Wound Care Center, subset data from a randomi zed, double-blind, placebo-controlled, parallel group clinical trial were r eviewed to compare the effects of three concentrations of rhPDGF-BB on full -thick ness pressure ulcers of the trunk with those of the placebo. Twenty- eight patients were enrolled and 27 completed the trial. An intent-to-treat analysis was used to evaluate data. If the ulcer did not heal by the end o f the 16 week trial period, the surgeon, still blinded to the treatment gro up, offered salvage surgical repair of the pressure ulcer. Eleven patients underwent salvage surgical repair using myocutaneous flaps, primary closure , or skin grafts. Of three patients who received placebo followed by surger y, none progressed to full healing within 1 year. Of 12 patients in the tre atment group who received rhPDGF-BB and salvage surgery, 11 (92 percent) ul timately healed the ulcers within 1 year after the start of the clinical tr ial. These findings suggest that treatment with rhPDGF-BB before surgery enhance s the ability to achieve a closed wound over surgery alone. It must yet be determined to what degree rhPDGF-BB contributed to the excellent results se en in the rhPDGF-BB/surgery group. It is possible that rhPDGF-BB "primes" t he local wound milieu to make it more responsive to complete closure follow ing surgical treatment.