Optimal wound length for complete vascular granulation using platelet-rich fibrin in an acute wound with tendon...

Treating wounds with exposed tendons following trauma is challenging, as addressing such injuries typically involves providing vascularised tissue coverage. Platelet-rich fibrin (PRF) is used to generate a granular wound bed for skin grafts. This study aimed to investigate the optimal wound length for complete vascular granulation using PRF treatment.

This was a retrospective case series study, conducted in the Affiliated Hospital of Nantong University, China. Between January 2016 and January 2020, patients with tendon-exposed wounds <4cm below the knee joint following acute traumatic injury were reviewed. The maximum wound diameter was measured and recorded, and the PRF clot was applied to the wound. Outcomes including the maximum wound diameter, number of patients with successful granulation and visual analogue scale (VAS) pain scores were measured. Successful healing was defined as complete wound re-epithelialisation. The receiver operating characteristic (ROC) curve was calculated to establish the threshold value for the preoperative maximum wound diameter to reliably predict complete granulation. A maximum wound diameter lower than the threshold value was considered to have a high chance of complete re-epithelialisation using the PRF treatment.

A total of 62 patients were included, with a mean age of 41.2±10.7 years. All patients had a high VAS pain score of 6.1±1.0 at eight hours after surgery. There was a significant decrease in VAS scores between the first and fifth days (6.2±2.3 versus 0.2±0.4, respectively; p<0.001). The cut-off value of the wound length derived was 2.25cm and the area under the curve was 0.993 (sensitivity: 0.957, specificity: 0.933; p<0.001).

The findings of this study demonstrated that a wound size of ≤2.25cm had a high possibility of achieving complete vascular granulation after PRF treatment in tendon-exposed wounds. It is therefore suggested that when treating patients with a wound diameter ≤2.25cm PRF should be used.