Platelet-Rich Plasma Therapy for Refractory Skin Ulcers: A Case Series of 12 Patients and Concise Review of the Literature

Abstract

Chronic skin ulcers remain a significant therapeutic challenge, particularly in patients with underlying medical conditions, and often prove difficult to treat with conventional methods. Platelet-rich plasma (PRP), an autologous preparation rich in growth factors, has garnered attention as a promising treatment option; however, its clinical efficacy remains inconsistent. In this study, we retrospectively evaluated 12 patients with refractory skin ulcers who received PRP therapy between 2018 and 2023. PRP was prepared from the patients' own blood and administered once weekly for 4 weeks; treatment efficacy was assessed based on the rate of reduction in ulcer area. Clinical outcomes varied depending on the etiology of the ulcer. Marked improvement was observed in patients with livedoid vasculopathy and burn-related ulcers, whereas moderate to marked improvement was seen in diabetic ulcers only when peripheral blood flow was preserved. In contrast, the response was minimal or absent in ulcers associated with pressure ulcers or peripheral arterial disease. Importantly, no adverse events were observed during treatment. These findings suggest that PRP therapy is a safe and potentially effective option for refractory skin ulcers, particularly in non-ischemic conditions. However, its efficacy appears to be limited in wounds involving ischemia or mechanical injury, highlighting the importance of appropriate patient selection and wound condition optimization. Further studies using standardized protocols are necessary to clarify its clinical indications.