1-800-MIDWEST
1-800-643-9378
Home
Login

Midwest Equine

Feature Article

Platelet Rich Fibrin | The Second Generation of Platelet Products is Here

Article Archives LinkPlatelet Rich Fibrin

Platelet Rich Fibrin

A CHRONIC ISSUE

Sammie was stocked up on her front end. She had developed an infection under the skin that over time, became a large open wound on the anterior portion of her cannon bone that would not heal. To complicate matters, the area had excessive tissue loss and could not be stitched closed. Even with daily cleaning and bandaging, Sammie’s veterinarians and owners began to fear they were fighting a losing battle.

A NOVEL SOLUTION

The ideal situation for a chronic wound like this or a traumatic wound that is slow healing or non-healing would be to suture the wound closed, allowing it to heal with the protection of the skin, without risk of contamination or further trauma. Unfortunately, Sammie’s wounds were so extensive that closure would not be possible without some medical intervention.

“We did have a conversation at one point of whether we would continue because it had been so long and costly,” Sammie’s owner stated in an emotional tone, “But you never want to hear that you may have to put your best friend down.”

Veterinarians are in the business of saving “best friends” and giving horse owners hope. In cases of chronic wounds or traumatic injuries, a more effective and economical solution was needed to replace the first generation of regenerative medicine that would deliver autologous platelets and beneficial growth factors to encourage healing with little scar tissue formation.

TREATMENT PLAN

Sammie was admitted to the Large Animal Clinic at Kansas State University, where they use Enso Discoveries exclusively for their regenerative medicine needs. Over the course of several days her legs went through a series of debridement accompanied with topical treatments with Enso Discoveries’ medical device, namely Platelet Rich Fibrin (PRF).

Sammie’s irregular, infected granulation tissue on the front aspect of both cannon bones had been unchanged for months, despite nearly $10,000 spent at an equine referral hospital. She needed healthy granulation beds to begin the healing process.

The first step was debriding away any obvious abnormal tissue. Samples were also submitted for bacteriology where contamination was confirmed. The next step was to apply growth factors to the area to fight the infection AND stimulate the production of healthy granulation tissue.

Platelet Rich Plasma (PRP) has been used for wound healing for years, but there is one major limitation: it is a liquid, thus if applied topically it will not stay in place for long. PRF, on the other hand, is a solid material that has been shown in human and animal studies to accelerate every phase of wound healing as well as help fight infection, thus it seemed like the best treatment option for Sammie.

The Enso Discoveries Rebound PRF kit uses a patient’s own blood to create a ‘living bandage.’ This PRF membrane, which is strong enough to be sutured to a wound, was then applied topically to Sammie’s wounds and bandaged accordingly. Bandages were changed every other day for a couple of weeks.

Around day 4 the veterinarians noticed that the PRF membranes, unlike any other topical bandage used in medicine, incorporated themselves into the wound bed. Clearly, this is one of the benefits of using an autologous product!

THE SCIENCE BEHIND PLATELET PRODUCTS

It is known that platelets and the formation of a provisional matrix play a prominent and likely determinant role in the initiation and maintenance of wound healing. Platelets are naturally activated by exposure to damaged tissue initiating a clotting cascade and primary hemostasis.

Upon activation, platelets release their granular contents into the wound environment including anabolic growth factors responsible for the initiation, propagation, and maintenance of all phases of healing.

Growth factors include plateletderived growth factors (PDGF), transforming growth factors (TGF-β), and vascular endothelial growth factors (VEGF). Individually and synergistically these growth factors stimulate angiogenesis, progenitor cell localization, and subsequent matrix production.

CURRENT PRODUCTS ON THE MARKET

Consider PRP, which is simply platelets suspended in plasma at a concentration greater than that of the whole blood of the patient from which it is drawn. For optimal results, a platelet product should be formulated for a specific wound.

Sammie’s wound, for instance, was an acute presentation with a chronic component exhibiting contaminants and infection. White blood cells (WBCs) to a contaminated wound would be indicated, yet hemoglobin contraindicated, inhibiting local tissue defenses. Finally, Sammie’s wound lacked sufficient healthy skin to suture closed.

A NEW PLATELET PRODUCT IS BORN

PRP contains platelets, growth factors, and +/- WBCs in liquid plasma. Formulate the platelets, growth factors (+/- WBCs) in a SOLID fibrin matrix for a secondgeneration platelet product— Platelet Rich Fibrin (PRF).

PRF does not require the addition of an anticoagulant like PRP does. Instead, whole blood is collected, immediately centrifuged, then allowed to clot. Depending on the g-forces applied during centrifugation, the clot will contain varying levels of platelets and leukocytes. The centrifuge settings are typically unique for each species, and validation has happened in five species thus far.

The fibrin clot, containing the platelets and growth factors, is separated from the red blood cells and compressed into a flexible sheet and applied as a biologic bandage to a wound. A bandage that does not have to be changed daily, but one that can be applied and left to do its job.

Unlike PRP and other first-generation platelet products that require injection, PRF is solid, applied only to the wound site and cannot stray. And unlike sterile bandages or synthetic grafts, PRF is autologous and carries no risk of rejection, or complication, no matter where it is applied. In many cases PRF will incorporate into the wound and be fully resorbed. Additionally, it has shown effective with other regenerative medicine products including PRP and stem cell.

Within a few weeks, not only had Sammie’s wounds healed, but the hair also grew back AND her temperament improved because she was no longer in chronic pain! Ten months after being discharged, Sammie was back in the show ring winning ribbons and hearts.

ADDITIONAL USES FOR PRF

  • Dentistry (extractions, wound closure)
  • Bone regeneration
  • Graft stabilization
  • Hemostasis
  • And much more


BIOGRAPHY

Corey Orava, DV, serves as the Chief Scientific Officer in charge of all scientific affairs and new product development at Enso Discoveries. His ability to design, develop, and validate new products for the veterinary industry is second to none.

Dr. Orava is also a sought-after regenerative medicine speaker both nationally and internationally. Dr. Orava received his Doctor of Veterinary Medicine degree with honors from the Ontario Veterinary College.

First introduced to step cell treatment and regenerative medicine in the early 2000s, Dr. Orava was so impressed and inspired by the transformative therapy that he left his position as an equine veterinarian at a progressive sports horse practice to pursue full-time work with a California-based company that focused on veterinary regenerative medicine.

In addition to developing and validating medical products and devices for both the human and veterinary fields, Dr. Orava also chairs the Kansas Veterinary Regenerative Symposium, the first veterinary conference in the Midwest to foucs on regenerative medicine.