The Effectiveness of Autologous Platelet-Rich Plasma Topical Application Versus Injection in the Healing of Chronic Venous Ulcers

IntroductionChronic venous leg ulcers (VLUs) are common lower-limb wounds associated with delayed healing, recurrence, pain, impaired mobility, reduced quality of life, and increased healthcare costs.Although compression therapy remains the standard treatment, many ulcers heal slowly or remain resistant, highlighting the need for effective adjunctive therapies.Autologous platelet-rich plasma (PRP) is rich in platelets and growth factors that promote angiogenesis, fibroblast proliferation, collagen synthesis, granulation tissue formation, and re-epithelialization, making it a promising regenerative therapy for chronic venous ulcers.However, existing evidence is limited due to small sample sizes, methodological heterogeneity, and variability in PRP preparation.Systematic reviews have therefore recommended well-designed prospective randomized trials to establish its efficacy and safety. Aims and objectivesThe study aims to evaluate the clinical efficacy of PRP topical application, PRP injection, and saline dressings in chronic VLUs, with the primary objective based on complete ulcer healing and percentage reduction in ulcer size, while assessing ulcer recurrence and early treatment-related complications constituted the secondary endpoints.Recurrence here is defined as re-appearance of the ulcer after its complete healing at the same site. MethodologyThis prospective randomized controlled trial was conducted over 18 months at JSS Medical College and Hospital, Mysuru, Karnataka, India.A total of 63 adults with chronic VLUs (>6 weeks) were randomly allocated into three groups: group A (topical PRP dressing), group B (local PRP injection), and group C (saline dressing).All patients received a standard four-layer compression therapy.Autologous PRP was prepared using a double-spin centrifugation technique and administered weekly for four weeks.Patients were followed for six months.Primary outcomes included complete ulcer healing and percentage reduction in ulcer area, while recurrence and treatment-related complications were assessed as secondary outcomes using SPSS Version 28 (p < 0.05). ResultsBaseline comparability was noted among groups for age, sex, BMI, HbA1c, platelet count, ankle-brachial pressure index, ulcer duration, and initial ulcer area.At six weeks, complete healing of the ulcer was much greater in group B (33.3%) than in group A (9.5%) and group C (0%) (p = 0.0064).At three months, the mean ulcer area was minimal in group B (1.30 ± 1.61 cm²) compared to group A (3.15 ± 3.01 cm²) and group C (6.19 ± 4.49 cm²) (p < 0.0001).The percentage reduction in ulcer area at three months was highest in group B (91.80 ± 8.05%), followed by group A (78.29 ± 17.68%) and group C (62.34 ± 19.06%).The mean healing duration was the shortest in group B (11.20 ± 2.18 weeks) (p = 0.0001).The rates of recurrence and complications were minimal and similar. ConclusionAutologous PRP is a safe and effective adjunct for chronic VLUs.Both PRP topical application and injection improved healing compared with saline dressing, while PRP injection achieved earlier healing, greater ulcer area reduction, and shorter healing time, making it the preferred PRP delivery method.