Chronic
venous insufficiency (CVI) can cause
ulcers of the lower limb having the character of a full thickness
wound involving the subcutaneous tissues and fat. Healing requires
wound contraction, connective tissue formation and finally reepithelialization. To induce wound healing, on an underlying disturbed environment due to longterm effects of CVI, artificial stimuli may be needed. In a placebo controlled study we tried topical application of autologous
PDWHF (platelet derived wound healing factors), to achieve
ulcer healing and improve the microangiopathy surrounding of the
ulcer area, as there are decreased number of skin capillaries and reduction in cutaneous vascular reserve. Alterations of cutaneous circulation during the course of the study were documented by capillaroscopy, transcutaneous
oxygen pressure and
laser Doppler flux (LDF) measurements. We were able to recruit 15 patients a I suffering from chronic nonhealing
venous stasis ulcers. Eleven of the 15 patients agreed to participate in a placebo-controlled double blind study, whereas 4 patients agreed to participate only if they would be treated with
PDWHF. The median age and duration of ulceration of the 6 patients (3 male/3 female) treated with placebo were 71 years and 1089 days. The median age and duration of ulceration of the 9 patients (1 male/8 females) treated with
PDWHF were 66 years and 732 days.
Duration of therapy for the
PDWHF group was 91 days, as compared to 154 days for the placebo group. Despite 2 completely healed
ulcers, the expensive treatment did not reveal any significant clinical advantage. In den
PDWHF group an
ulcer area of 26.9 cm2 was measured at the beginning, of 26.2 cm2 at the end; in the placebo group, 34.7 cm2 and 35.5 cm2. The nonsignificant increase of the capillary density at the
ulcer border in the active group as well as the increase in the tcPO2, in contrast to little change in both parameters in the placebo group, suggests neoangiogenic abilities to
PDWHF, secondarily leading to a better blood distribution with higher
oxygen tension.