Pressure ulcers are tissue lesions, with necrotic evolution, affecting the epidermis, dermis and subcutaneous layers, up to, in the most severe cases, the muscles and bones. These lesions develop in anatomical regions subjected to high or prolonged pressure. The sites most frequently involved are the sacro-ischial region, the trochanteric region and the calcaneal region, and patients with reduced mobility (bedridden and / or in a wheelchair) have a higher risk of developing pressure ulcers, both because these areas body are constantly subjected to high pressure, both due to the decrease in muscle tone in these anatomical districts. The pathogenesis of these lesions is attributable to the ischemia of the superficial and deep tissues induced by the compression of the arteriolo-capillary district, with consequent tissue necrosis. To date, there is no gold standard for the treatment of pressure ulcers. The approaches commonly used in the medical field are represented by infusional, nutritional, antibiotic therapies and by an accurate local cleansing. In the surgical field, on the other hand, the treatment of pressure ulcers usually involves the removal of necrotic tissues (debridement), until reaching a vital tissue level, and the contextual application of VAC (Vacuum Assisted Closure) Therapy. In selected cases, and in the absence of over-infection, reconstructive techniques are used, represented by dermo-epidermal grafts, composite flaps (bundle-cutaneous and myocutaneous), perforating flaps (cutaneous-adipose) and flaps free. In recent years, even the grafts of adipose tissue (lipofilling) find a localization in the treatment of bedsores, especially in the advanced clinical stages (> II sec. National Pressure Advisory Panel). A recent clinical trial demonstrated a therapeutic role of lipofilling in the treatment of early stage pressure ulcers. Considering that the spontaneous healing of these lesions is not possible, also due to the over-infections they can undergo, the surgical approach is often the treatment of choice. However, it involves invasive, expensive interventions, requires long rehabilitation periods with further worsening of the patient's quality of life and is not free from relapses. To overcome these problems, the solution could be to be able to prevent the formation of pressure ulcers from the earliest stages. The idea of this research project stems from the increasingly accredited and established belief that adipose tissue is a source of adult stem cells (ASCs), some of which are capable of differentiating into different cell lines. Analysis of lipoaspirate samples in fact demonstrated the presence of ASCs, endothelial cells, leukocytes and other cellular elements, which constitute the so-called stromal vascular fraction (SVF). ASCs possess proangiogenic properties, through the release of growth factors and proangiogenic factors (eg VEGF and IL-8), and also have the ability to differentiate into vascular endothelial cells. The graft of adipose tissue initially induces an insult at the recipient site, represented by bleeding and platelet activation with the release of numerous growth factors (PDGF, TGF-beta ;, EGF). At the same time, damaged tissues, especially MEC and necrotic cells, release bFGF which in turn stimulates the release of HGF by the ASCs, which promotes neo-adipogenesis and angiogenesis. Platelet Rich Plasma (PRP) is an autologous concentrate of platelets suspended in a small volume of plasma and is therefore considered a blood product, as defined by current legislation. Platelets possess pro-inflammatory, regulatory and regenerative properties mediated by the interaction with some cells (neutrophils, endothelial cells) and by the release of growth factors (GFs), chemokines and other regulatory molecules. PRP therefore contains numerous molecules that play a fundamental role in the tissue repair process; some of these molecules are factors contained in the alpha granules of platelets, while others are blood proteins, such as fibrin, fibronectin and vitronectin. Recent clinical trials have shown that PRP, in addition to its regenerative properties mainly linked to the stimulation of fibroblasts, possesses in vitro the ability to increase the number of ASCs contained in adipose tissue grafts. In vivo, PRP increases the survival and function of adipose tissue grafts, also through the stimulation of neoangiogenesis and fibrogenic activity of fibroblasts, resulting in a more adequate three-dimensional organization of adipocytes. Recent experimental studies have shown that the ultrasound investigation of the superficial and deep tissues of the anatomical regions at high risk allows to identify the presence of negative prognostic factors for the development of pressure sores, such as edema and structural inhomogeneity of the subcutaneous adipose tissue, present in the early stages of a pressure ulcer. These findings are reversible and regress with the healing of the lesion, unlike tissue necrosis, always highlighted by ultrasound images, which persists when the pressure ulcer is in an advanced stage. Therefore, ultrasound is an effective technique for the early identification of the genesis and progression of the pressure ulcer. The main purpose of this research project, based on the results of clinical trials that have demonstrated the regenerative capacity of adipose tissue, the advantage deriving from the combination of PRP with adipose tissue grafts and the correlation between specific ultrasound parameters and the development of pressure ulcers, is to evaluate the potential benefits of lipofilling / PRP both in the treatment of pressure sores in the early clinical stages of the disease (Grade I and II sec. NPUAP) and in the prevention of their formation when, although not clinically evident, there are precise prognostic and structural factors that lead to suspect, in the region in which they are present, a formation of pressure ulcers.

Pressure ulcers are tissue lesions, with necrotic evolution, affecting the epidermis, dermis and subcutaneous layers, up to, in the most severe cases, the muscles and bones. These lesions develop in anatomical regions subjected to high or prolonged pressure. The sites most frequently involved are the sacro-ischial region, the trochanteric region and the calcaneal region, and patients with reduced mobility (bedridden and / or in a wheelchair) have a higher risk of developing pressure ulcers, both because these areas body are constantly subjected to high pressure, both due to the decrease in muscle tone in these anatomical districts. The pathogenesis of these lesions is attributable to the ischemia of the superficial and deep tissues induced by the compression of the arteriolo-capillary district, with consequent tissue necrosis. To date, there is no gold standard for the treatment of pressure ulcers. The approaches commonly used in the medical field are represented by infusional, nutritional, antibiotic therapies and by an accurate local cleansing. In the surgical field, on the other hand, the treatment of pressure ulcers usually involves the removal of necrotic tissues (debridement), until reaching a vital tissue level, and the contextual application of VAC (Vacuum Assisted Closure) Therapy. In selected cases, and in the absence of over-infection, reconstructive techniques are used, represented by dermo-epidermal grafts, composite flaps (bundle-cutaneous and myocutaneous), perforating flaps (cutaneous-adipose) and flaps free. In recent years, even the grafts of adipose tissue (lipofilling) find a localization in the treatment of bedsores, especially in the advanced clinical stages (> II sec. National Pressure Advisory Panel). A recent clinical trial demonstrated a therapeutic role of lipofilling in the treatment of early stage pressure ulcers. Considering that the spontaneous healing of these lesions is not possible, also due to the over-infections they can undergo, the surgical approach is often the treatment of choice. However, it involves invasive, expensive interventions, requires long rehabilitation periods with further worsening of the patient's quality of life and is not free from relapses. To overcome these problems, the solution could be to be able to prevent the formation of pressure ulcers from the earliest stages. The idea of this research project stems from the increasingly accredited and established belief that adipose tissue is a source of adult stem cells (ASCs), some of which are capable of differentiating into different cell lines. Analysis of lipoaspirate samples in fact demonstrated the presence of ASCs, endothelial cells, leukocytes and other cellular elements, which constitute the so-called stromal vascular fraction (SVF). ASCs possess proangiogenic properties, through the release of growth factors and proangiogenic factors (eg VEGF and IL-8), and also have the ability to differentiate into vascular endothelial cells. The graft of adipose tissue initially induces an insult at the recipient site, represented by bleeding and platelet activation with the release of numerous growth factors (PDGF, TGF-beta ;, EGF). At the same time, damaged tissues, especially MEC and necrotic cells, release bFGF which in turn stimulates the release of HGF by the ASCs, which promotes neo-adipogenesis and angiogenesis. Platelet Rich Plasma (PRP) is an autologous concentrate of platelets suspended in a small volume of plasma and is therefore considered a blood product, as defined by current legislation. Platelets possess pro-inflammatory, regulatory and regenerative properties mediated by the interaction with some cells (neutrophils, endothelial cells) and by the release of growth factors (GFs), chemokines and other regulatory molecules. PRP therefore contains numerous molecules that play a fundamental role in the tissue repair process; some of these molecules are factors contained in the alpha granules of platelets, while others are blood proteins, such as fibrin, fibronectin and vitronectin. Recent clinical trials have shown that PRP, in addition to its regenerative properties mainly linked to the stimulation of fibroblasts, possesses in vitro the ability to increase the number of ASCs contained in adipose tissue grafts. In vivo, PRP increases the survival and function of adipose tissue grafts, also through the stimulation of neoangiogenesis and fibrogenic activity of fibroblasts, resulting in a more adequate three-dimensional organization of adipocytes. Recent experimental studies have shown that the ultrasound investigation of the superficial and deep tissues of the anatomical regions at high risk allows to identify the presence of negative prognostic factors for the development of pressure sores, such as edema and structural inhomogeneity of the subcutaneous adipose tissue, present in the early stages of a pressure ulcer. These findings are reversible and regress with the healing of the lesion, unlike tissue necrosis, always highlighted by ultrasound images, which persists when the pressure ulcer is in an advanced stage. Therefore, ultrasound is an effective technique for the early identification of the genesis and progression of the pressure ulcer. The main purpose of this research project, based on the results of clinical trials that have demonstrated the regenerative capacity of adipose tissue, the advantage deriving from the combination of PRP with adipose tissue grafts and the correlation between specific ultrasound parameters and the development of pressure ulcers, is to evaluate the potential benefits of lipofilling / PRP both in the treatment of pressure sores in the early clinical stages of the disease (Grade I and II sec. NPUAP) and in the prevention of their formation when, although not clinically evident, there are precise prognostic and structural factors that lead to suspect, in the region in which they are present, a formation of pressure ulcers.

Impiego del PRP (Platelet-Rich Plasma) combinato con gli innesti di tessuto adiposo nella prevenzione e nel trattamento delle ulcere da decubito / Vito Toto - : . , 2019 Mar 20. ((31. ciclo

Impiego del PRP (Platelet-Rich Plasma) combinato con gli innesti di tessuto adiposo nella prevenzione e nel trattamento delle ulcere da decubito

2019-03-20

Abstract

Pressure ulcers are tissue lesions, with necrotic evolution, affecting the epidermis, dermis and subcutaneous layers, up to, in the most severe cases, the muscles and bones. These lesions develop in anatomical regions subjected to high or prolonged pressure. The sites most frequently involved are the sacro-ischial region, the trochanteric region and the calcaneal region, and patients with reduced mobility (bedridden and / or in a wheelchair) have a higher risk of developing pressure ulcers, both because these areas body are constantly subjected to high pressure, both due to the decrease in muscle tone in these anatomical districts. The pathogenesis of these lesions is attributable to the ischemia of the superficial and deep tissues induced by the compression of the arteriolo-capillary district, with consequent tissue necrosis. To date, there is no gold standard for the treatment of pressure ulcers. The approaches commonly used in the medical field are represented by infusional, nutritional, antibiotic therapies and by an accurate local cleansing. In the surgical field, on the other hand, the treatment of pressure ulcers usually involves the removal of necrotic tissues (debridement), until reaching a vital tissue level, and the contextual application of VAC (Vacuum Assisted Closure) Therapy. In selected cases, and in the absence of over-infection, reconstructive techniques are used, represented by dermo-epidermal grafts, composite flaps (bundle-cutaneous and myocutaneous), perforating flaps (cutaneous-adipose) and flaps free. In recent years, even the grafts of adipose tissue (lipofilling) find a localization in the treatment of bedsores, especially in the advanced clinical stages (> II sec. National Pressure Advisory Panel). A recent clinical trial demonstrated a therapeutic role of lipofilling in the treatment of early stage pressure ulcers. Considering that the spontaneous healing of these lesions is not possible, also due to the over-infections they can undergo, the surgical approach is often the treatment of choice. However, it involves invasive, expensive interventions, requires long rehabilitation periods with further worsening of the patient's quality of life and is not free from relapses. To overcome these problems, the solution could be to be able to prevent the formation of pressure ulcers from the earliest stages. The idea of this research project stems from the increasingly accredited and established belief that adipose tissue is a source of adult stem cells (ASCs), some of which are capable of differentiating into different cell lines. Analysis of lipoaspirate samples in fact demonstrated the presence of ASCs, endothelial cells, leukocytes and other cellular elements, which constitute the so-called stromal vascular fraction (SVF). ASCs possess proangiogenic properties, through the release of growth factors and proangiogenic factors (eg VEGF and IL-8), and also have the ability to differentiate into vascular endothelial cells. The graft of adipose tissue initially induces an insult at the recipient site, represented by bleeding and platelet activation with the release of numerous growth factors (PDGF, TGF-beta ;, EGF). At the same time, damaged tissues, especially MEC and necrotic cells, release bFGF which in turn stimulates the release of HGF by the ASCs, which promotes neo-adipogenesis and angiogenesis. Platelet Rich Plasma (PRP) is an autologous concentrate of platelets suspended in a small volume of plasma and is therefore considered a blood product, as defined by current legislation. Platelets possess pro-inflammatory, regulatory and regenerative properties mediated by the interaction with some cells (neutrophils, endothelial cells) and by the release of growth factors (GFs), chemokines and other regulatory molecules. PRP therefore contains numerous molecules that play a fundamental role in the tissue repair process; some of these molecules are factors contained in the alpha granules of platelets, while others are blood proteins, such as fibrin, fibronectin and vitronectin. Recent clinical trials have shown that PRP, in addition to its regenerative properties mainly linked to the stimulation of fibroblasts, possesses in vitro the ability to increase the number of ASCs contained in adipose tissue grafts. In vivo, PRP increases the survival and function of adipose tissue grafts, also through the stimulation of neoangiogenesis and fibrogenic activity of fibroblasts, resulting in a more adequate three-dimensional organization of adipocytes. Recent experimental studies have shown that the ultrasound investigation of the superficial and deep tissues of the anatomical regions at high risk allows to identify the presence of negative prognostic factors for the development of pressure sores, such as edema and structural inhomogeneity of the subcutaneous adipose tissue, present in the early stages of a pressure ulcer. These findings are reversible and regress with the healing of the lesion, unlike tissue necrosis, always highlighted by ultrasound images, which persists when the pressure ulcer is in an advanced stage. Therefore, ultrasound is an effective technique for the early identification of the genesis and progression of the pressure ulcer. The main purpose of this research project, based on the results of clinical trials that have demonstrated the regenerative capacity of adipose tissue, the advantage deriving from the combination of PRP with adipose tissue grafts and the correlation between specific ultrasound parameters and the development of pressure ulcers, is to evaluate the potential benefits of lipofilling / PRP both in the treatment of pressure sores in the early clinical stages of the disease (Grade I and II sec. NPUAP) and in the prevention of their formation when, although not clinically evident, there are precise prognostic and structural factors that lead to suspect, in the region in which they are present, a formation of pressure ulcers.
Pressure ulcers are tissue lesions, with necrotic evolution, affecting the epidermis, dermis and subcutaneous layers, up to, in the most severe cases, the muscles and bones. These lesions develop in anatomical regions subjected to high or prolonged pressure. The sites most frequently involved are the sacro-ischial region, the trochanteric region and the calcaneal region, and patients with reduced mobility (bedridden and / or in a wheelchair) have a higher risk of developing pressure ulcers, both because these areas body are constantly subjected to high pressure, both due to the decrease in muscle tone in these anatomical districts. The pathogenesis of these lesions is attributable to the ischemia of the superficial and deep tissues induced by the compression of the arteriolo-capillary district, with consequent tissue necrosis. To date, there is no gold standard for the treatment of pressure ulcers. The approaches commonly used in the medical field are represented by infusional, nutritional, antibiotic therapies and by an accurate local cleansing. In the surgical field, on the other hand, the treatment of pressure ulcers usually involves the removal of necrotic tissues (debridement), until reaching a vital tissue level, and the contextual application of VAC (Vacuum Assisted Closure) Therapy. In selected cases, and in the absence of over-infection, reconstructive techniques are used, represented by dermo-epidermal grafts, composite flaps (bundle-cutaneous and myocutaneous), perforating flaps (cutaneous-adipose) and flaps free. In recent years, even the grafts of adipose tissue (lipofilling) find a localization in the treatment of bedsores, especially in the advanced clinical stages (> II sec. National Pressure Advisory Panel). A recent clinical trial demonstrated a therapeutic role of lipofilling in the treatment of early stage pressure ulcers. Considering that the spontaneous healing of these lesions is not possible, also due to the over-infections they can undergo, the surgical approach is often the treatment of choice. However, it involves invasive, expensive interventions, requires long rehabilitation periods with further worsening of the patient's quality of life and is not free from relapses. To overcome these problems, the solution could be to be able to prevent the formation of pressure ulcers from the earliest stages. The idea of this research project stems from the increasingly accredited and established belief that adipose tissue is a source of adult stem cells (ASCs), some of which are capable of differentiating into different cell lines. Analysis of lipoaspirate samples in fact demonstrated the presence of ASCs, endothelial cells, leukocytes and other cellular elements, which constitute the so-called stromal vascular fraction (SVF). ASCs possess proangiogenic properties, through the release of growth factors and proangiogenic factors (eg VEGF and IL-8), and also have the ability to differentiate into vascular endothelial cells. The graft of adipose tissue initially induces an insult at the recipient site, represented by bleeding and platelet activation with the release of numerous growth factors (PDGF, TGF-beta ;, EGF). At the same time, damaged tissues, especially MEC and necrotic cells, release bFGF which in turn stimulates the release of HGF by the ASCs, which promotes neo-adipogenesis and angiogenesis. Platelet Rich Plasma (PRP) is an autologous concentrate of platelets suspended in a small volume of plasma and is therefore considered a blood product, as defined by current legislation. Platelets possess pro-inflammatory, regulatory and regenerative properties mediated by the interaction with some cells (neutrophils, endothelial cells) and by the release of growth factors (GFs), chemokines and other regulatory molecules. PRP therefore contains numerous molecules that play a fundamental role in the tissue repair process; some of these molecules are factors contained in the alpha granules of platelets, while others are blood proteins, such as fibrin, fibronectin and vitronectin. Recent clinical trials have shown that PRP, in addition to its regenerative properties mainly linked to the stimulation of fibroblasts, possesses in vitro the ability to increase the number of ASCs contained in adipose tissue grafts. In vivo, PRP increases the survival and function of adipose tissue grafts, also through the stimulation of neoangiogenesis and fibrogenic activity of fibroblasts, resulting in a more adequate three-dimensional organization of adipocytes. Recent experimental studies have shown that the ultrasound investigation of the superficial and deep tissues of the anatomical regions at high risk allows to identify the presence of negative prognostic factors for the development of pressure sores, such as edema and structural inhomogeneity of the subcutaneous adipose tissue, present in the early stages of a pressure ulcer. These findings are reversible and regress with the healing of the lesion, unlike tissue necrosis, always highlighted by ultrasound images, which persists when the pressure ulcer is in an advanced stage. Therefore, ultrasound is an effective technique for the early identification of the genesis and progression of the pressure ulcer. The main purpose of this research project, based on the results of clinical trials that have demonstrated the regenerative capacity of adipose tissue, the advantage deriving from the combination of PRP with adipose tissue grafts and the correlation between specific ultrasound parameters and the development of pressure ulcers, is to evaluate the potential benefits of lipofilling / PRP both in the treatment of pressure sores in the early clinical stages of the disease (Grade I and II sec. NPUAP) and in the prevention of their formation when, although not clinically evident, there are precise prognostic and structural factors that lead to suspect, in the region in which they are present, a formation of pressure ulcers.
Impiego del PRP (Platelet-Rich Plasma) combinato con gli innesti di tessuto adiposo nella prevenzione e nel trattamento delle ulcere da decubito / Vito Toto - : . , 2019 Mar 20. ((31. ciclo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/68859
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