Growth Factors. Platelet Rich Plasma

What are they and how growth factors act?

The growth factor PDGF Platelet-derived (English, PDGF, by platelet derived growth factor) is one of many growth factors, or proteins that regulate cell growth and cell division. Growth factor, platelet derived plays a significant role in angiogenesis, involving the growth and formation of blood vessels from existing vascular tissue.

Growth factor, platelet derived was among the first to be discovered and isolated, has the ability to act on a wide variety of cells, You bone, fibroblasts, neuroglia, muscle, and other, therefore classified as a broad specificity factor. Is stored in the alpha granules of platelets.

This factor acts on fibroblasts greatly increasing their proliferation, chemotaxis and also increases the production of extracellular substance (collagen fibers). Also acts on osteoblasts to increase their proliferation. Has chemotactic effect on monocytes and macrophages to the wound area by attracting to increase defenses.

Other growth factors found in the alpha granules of platelets is the vascular endothelial growth factor (FCVE). It is a potent mitogen for endothelial cells only, therefore has an important angiogenic action.

Why are used in trauma and orthopedic surgery?

Injection of growth factors into the damaged area is an especially useful technique for recovering lesions poorly vascularized structures such as ligaments, tendons, cartilages the fasciae. If this therapy recurre, especially, to chronic injuries (tendinopatías, pubalgias, tennis elbow, degeneration of cartilage and other). It can also be used to recover muscle injuries, bone regeneration and accelerate the recovery process after surgery.

How are they used?

Growth factors are obtained from platelets of a patient's own blood.

A small volume of blood is drawn to the patient (between 20 and 80 ml). Stored in tubes and centrifuged. Thus, blood is separated into its three basic components:

• Platelet-poor plasma
• Plasma with a similar number of the blood platelets
• Platelet Rich Plasma (PRP), that is of interest and where the growth factors are released.

Growth factors are injected into different areas of the lesion and there are different techniques.

How many infiltration should be performed?

In injury depends tendinosis, but usually performed two to three injections at intervals of a week or fortnightly. Should be made in extreme aseptic. Skin and subcutaneous tissue is infiltrated with previously 2- 3 ml of local anesthetic. After 2 minutes, gauge needle 22 G, injected 3- 5 ml (depending on the treatment area) platelet concentrate buffered so that it is balanced with the pH of the tissue.

When used in nonunion fractures or surgery should be done as part of the operation, and is usually mixed with bone graft from the iliac crest of the patient's own, also need more quantity.

Its use in states preartrósicos, osteoarthritis or moderate swivel condromalacias be performed in the operating room is preferable. In these conditions requires a prior evaluation by the specialist, to study all necessary tests to rule out diseases or injuries that require different treatments. For example, in a patient with less than 50 age, that you have a meniscus removed and has a constant and severe pain in the knee, but retains cartilage, does not solve the problem unless you trasplantemos a meniscus.

It can also be used after performing arthroscopy of joints that need it.

Do you have unwanted effects or contraindications?

Obtained from the patient to no allergic reactions. All necessary precautions must be taken to prevent infection.

Indications in trauma and orthopedic surgery.

• Codo of tenista or lateral epicondilitis.
• Codo del golfer the epitrocleitis.
• Plantar fasciitis.
• Tendon Aquileia.
• Patellar tendonitis or jumper's knee.
• Delayed union and nonunion of fractures.
• In bone deficiencies and cases of application of grafts.
• Diabetic Foot.
• Wound healing, delays the healing of defects.
• Fractures.
• Osteoarthritis (loss of articular cartilage in hip, knee, shoulder, elbow and other).