1545_Fridman.pdf

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1、Robert Fridman,DPM,FACFAS,CWSPDepartment of Orthopaedic SurgeryColumbia University Medical CenterNew York,NYPlatelet Rich Fibrin Matrix in the Treatment of Hard-To-Heal DFUsOutlineWhat is PRP?How do you make PRP?What is PRFM and how is it different from PRP?Review of new clinical data on PRFM on DFU

2、sWhole BloodPlateletsSmall,granulated bodies7 day half-lifeProduced in bone marrowStored in spleenInvolved in initial phase of wound healingContain Ca+,K+,clotting factors,serotonin,ADP,prostaglandins,and growth factorsPlasmaFluid portion of bloodContains proteins,antibodies,clotting factors,and ion

3、sAbout 5%of body weightPlasma clots of standingMust add anticoagulant to whole blood to harvest plasmaPlatelet FunctionHemostasisScaffoldGrowth FactorsStem Cell BindingDefinition of PRPA preparation of platelets concentrated in a limited volume of plasma3-5x increase in platelets and growth factors

4、per volume of plasmaNo significant information about platelet concentrations that is optimal for healing of tissuesPlateletsNormal Peripheral SmearPlatelet Rich SmearPlateletsResting StateActivated PlateletsGrowth FactorsLinear increase with platelet concentrationMarx RE,.Implant Dent.2001;10(4):225

5、-8.Growth Factors(GF)Directional movement in response to chemical stimulusChemotaxis Stem cells attracted to growth factors and migrate to areaMigration Cell division in response to a stimulusProliferation GF binds to stem cell membrane and stimulates cell divisionPlatelet SignalingSome Growth Facto

6、rs in PRPPDGF Chemoattractive for WBCs and mesenchymal stem cellsTGF-B Promotes cell mitosis Increases Type-I collagen production in tendon sheath fibroblasts Klein et.al,.J Hand SurgAm.2002 Jul;27(4):615-20)VEGF Stimulates angiogenesisGrowth Factors in PRPPDGF 17 ng/ml(5x increase over whole blood)