Efficacy of Platelet-Rich Plasma in Reduction of Post-Operative Split-Thickness Skin Graft Loss and Hematoma Formation: A Meta-Analysis

Efficacy of Platelet-Rich Plasma in Reduction of Post-Operative Split-Thickness Skin Graft Loss and Hematoma Formation: A Meta-Analysis

Apurv Gupta
Maulana Azad Medical College, New Delhi, Iceland

Introduction: Split-thickness skin grafting is a popular technique of wound closure, especially for large wounds. The success rate of a split-thickness skin graft (STSG) has consistently been in the range of 70-90%. We evaluated the impact of Platelet-rich plasma (PRP) use on the survival of STSG through a meta-analysis.

Methods: We conducted the analysis in accordance to PRISMA protocol and performed a literature search using the following databases: PubMed, Cochrane, and ClinicalTrials.gov. A total of 126 articles were yielded by the search, out of which four RCTs were included according to our eligibility. The intervention group received PRP application to the wound bed before applying the graft while the control group received treatment with conventional fixation procedures (sutures and staples). We estimated the pooled odds ratio with a 95% confidence interval (CI). The total number of participants in the analysis were 460. Post-operative graft loss and hematoma formation were taken to be the primary and secondary outcome measures, respectively.

Results: 34 participants suffered graft loss of differing extent in the control group while 3 participants suffered graft loss in the intervention group. The pooled odds ratio for graft loss was 0.15 (95% CI: 0.05-0.49; I2=38%; p=0.184). For our secondary outcome measure, 440 participants were studied. 44 participants suffered hematoma formation in the control group versus 11 in the intervention group. The pooled odds ratio for hematoma formation was calculated as 0.21 (95% CI: 0.09-0.50; I2=0%; p=0.869).

Conclusions: The use of PRP decreased the odds of graft loss by 85% and the odds of hematoma formation decreased by 79%. PRP appears to significantly impact graft survival, and further studies are needed to strengthen the evidence base for its use in split-thickness skin grafting.

Keywords: split-thickness skin graft, graft recipient bed preparation, wound reconstruction, wound repair, platelet- rich plasma