Use of platelet-rich plasma with split-thickness skin grafts in the high-risk patient

Split-thickness skin grafting (STSG) is commonly employed for soft-tissue coverage because of its broad application for use, ease of harvest, and universal equipment. STSG healing proceeds through 3 stages: (1) anchorage, (2) inosculation, and (3) maturation. The success of the first 2 stages is critical to the overall success. Bolster dressings of various types are universally applied to create apposition of the skin graft with the granular bed, thereby preventing shearing forces and fluid accumulation until vascular ingrowth can occur. The application of autologous platelet-rich plasma (PRP) to STSG application sites has been recently described and theorized to provide immediate skin graft anchorage as well as inosculation of the STSG with nutrient-rich blood media. This study was performed to report the time to >or=90% primary healing of STSGs augmented with application of PRP in a high-risk patient population. The mean time to >or=90% STSG recipient site healing was 16 +/- 4.2 days, as determined by retrospective chart review and digital photograph analysis. The addition of PRP to STSG recipient sites seems to enhance primary healing and reduce healing time, likely as a result of shearing force reduction and enhancement of the wound environment with growth factors.