Use of Platelet Rich Plasma (PRP) and Hyaluronic Acid in Treatment of Extremity Gunshot Injuries: A Case Report

Abstract

DEAR EDITOR In the view of efficiency and cost effectiveness the increasing incidence of gunshot wounds demands a modification of treatment protocols. The general basis are antibiotics, fracture stabilization and debridement of soft tissue injuries. The pathology of gunshot wounds and established treatment algorithm however have to be adjusted to the ongoing development of gun technology and the thereby caused specific lesions. In most of the cases it is difficult to obtain a complete healing, because of the complexity of different tissues. Moreover the presence of foreign bodies and the tendency to develop infections, slow down the healing process.1 There are many ways to treat firearm wound such as advanced dressings, negative pressure wound therapy, surgical toilet, dermal substitute and autologous skin grafting, free or local flaps. It depends on the extent of lesion, the type of firearm, the localization and the general health of patient.2 The purpose of our case report was to determine how platelet rich plasma (PRP) and hyaluronic acid (HA) help healing of extremity gunshot injuries. A 52-year-old male admitted to our department presented with a gunshot wound of lower left limb without comorbidities, smoker of 50 cigarettes per day. The patient was accidentally insult by a shotgun in 9 December 2008. He was instantly brought to the hospital emergency room. In the emergency room, the initial assessment entire patient was performed by the trauma team, then the wound was sterilely dressed and a splint was applied to the limb. This wound was characterized by the presence of the shotgun cartridge wad and widespread contamination from foreign materials shredded in the wound by the shot blast. The initial depth of the wound was 4 cm and width was 3.6 cm (Figure 1). In the meantime the patient was underwent radiographic evaluation. The purpose of a radiographic examination was not only to assess the extent of hard and soft tissue destruction but also locate foreign bodies and plan surgery. Conventional radiography does depict the bullet and its site, subcutaneous emphysema, blow-out fractures and the location of bone splinters. This permits adequate emergency surgery and an efficacious orthopedic approach, as well as selection of the cases to be submitted to clinical monitoring. The radiographic examination showed a multi-fragmented fracture of distal end of tibia and also a fracture of fibula, well as numerous radiopaque foreign bodies (Figure 2). After the response from the radiograph, the patient was subjected to an operation in which was performed an adequate debridement of wound to remove unhealthy tissue and foreign bodies, but it was Letter to Editor

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@inproceedings{Cervelli2016UO, title={ Use of Platelet Rich Plasma (PRP) and Hyaluronic Acid in Treatment of Extremity Gunshot Injuries: A Case Report }, author={Valerio Cervelli and Pietro Gentile and Lorenzo Brinci and Camilla Di Pasquali and Ilaria Bocchini and Barbara De Angelis}, booktitle={World journal of plastic surgery}, year={2016} }