Platelet Rich Fibrin in Combination With Topical Antibiotics or Antiseptics in the Treatment of Chronic Wounds - a Prospective, Randomized, Active Controlled, Double Blind Pilot Trial With an Observer-blinded Control Group
Overview
- Phase
- N/A
- Intervention
- PRF mixed with amikacin and teicoplanin
- Conditions
- Chronic Skin Ulcer
- Sponsor
- Medical University of Vienna
- Enrollment
- 120
- Locations
- 1
- Primary Endpoint
- reduction in wound area
- Status
- Recruiting
- Last Updated
- 4 years ago
Overview
Brief Summary
Platelet rich fibrin (PRF) is a new therapy option for chronic wounds with yet unproven therapeutic efficacy. This randomised controlled trial aims to provide evidence of the efficacy of PRF as monotherapy as well as a growth promoting carrier matrix for antimicrobial compounds. The investigators therefore designed a four armed trial with three PRF arms which are compared to each other as well as to an active comparator. The treatment arms are as follows:
Study arm 1: PRF with amikacin and teicoplanin Study arm 2: PRF with placebo (0.9% sodium chloride) Study arm 3: PRF with PHMB (polyhexanid) plus Macrogolol (Lavasorb®) Study arm 4: Acticoat 7® wound dressing as active control Patients with infected chronic wounds may be included in this trial. Infection shall be diagnosed by an experienced senior infectious diseases specialist. Patients with untreated peripheral vascular occlusive disease as defined by an ABI (ancle brachial index) of < 0,7 are excluded from the trial as are patients with an uncontrolled diabetes mellitus or patients who have not received sufficient treatment for a diabetic foot syndrome. Any underlying illness will be treated following standard of care. In case of chronic venous insufficiency four-layered compression bandages will be applied each visit if tolerated by the patient. Alternatively compression stockings (Class III) are permitted. This is mentioned as "Disease specific treatment" in the protocol.
Patients will receive treatment for 56 days. After 28 and 56 days the wound surface will be compared to the baseline. Infection parameters (c-reactive protein and leucocyte count) will be measured weekly. Evaluation of systemic antimicrobial therapy will be performed at each visit. Systemic antimicrobial therapy is started at the discretion of a senior infectious diseases specialist.
Investigators
Florian Thalhammer
Univ.-Prof. Dr.med.univ.
Medical University of Vienna
Eligibility Criteria
Inclusion Criteria
- •Males and females aged over 18 who are able to give informed consent
- •Chronic venous ulcer with localized non-systemic soft-tissue infection diagnosed by senior infectious diseases specialist based on US FDA Guidance for Industry Chronic cutaneous ulcer and burn wounds June 2006:
- •slough and necrotic tissue
- •inflammation
- •presence of granulation tissue
- •Wound size ≥ 5 cm2 and \< 200 cm2
Exclusion Criteria
- •Non-treated diabetes mellitus, HbA1c \> 12 mg/dl
- •Non treated (orthopaedic shoe) diabetic foot syndrome
- •ABI \< 0,7
- •Wound size 15 cm2 and \> 200 cm2
- •CRP \> 5 mg/dl
- •Leucocytes \> 15.000 /μl
- •Infection of another site
- •Infection of the ulcer with a pathogen with inherent resistance to amikacin and teicoplanin
- •Known osteomyelitis
- •Known erysipelas
Arms & Interventions
Study arm 1 - PRF plus amikacin and teicoplanin
PRF mixed with amikacin and teicoplanin is sprayed on the patients' ulcer
Intervention: PRF mixed with amikacin and teicoplanin
Study arm 2 - PRF plus normal saline
PRF mixed with normal saline is sprayed on the patients' ulcer
Intervention: PRF plus normal saline
Study arm 3 - PRF mixed with PHMB plus Macrogolol
PRF mixed with polyhexanide and macrogolol is sprayed on the patients' ulcer
Intervention: PRF mixed with PHMB plus Macrogolol
Study arm 4 - Acticoat 7
A silver gauze (Acticoat 7®) is applied to the patients' ulcer
Intervention: Silver gauze
Outcomes
Primary Outcomes
reduction in wound area
Time Frame: day 56
Secondary Outcomes
- Number of patients in necessity to initiate systemic antimicrobial therapy based on the opinion of a senior infectious disease consultant arises (subjective assessment based on wound inflammation, serum c-reactive protein levels and leucocyte count)(day 0, 7, 14, 21, 28, 35, 42, 49, 56)
- Elevation of C-reactive protein over 7 mg/dl (normal value 0.5 mg/dl)(day 0, 7, 14, 21, 28, 35, 42, 49, 56)
- time to sterility of the wound(day 0, 7, 14, 21, 28, 35, 42, 49, 56)
- Relative wound volume and wound area reduction(on day 28 and 56)
- Occurrence of drug resistant bacteria in the wound(day 0, 7, 14, 21, 28, 35, 42, 49, 56)
- Occurrence of drug resistant bacteria in a swab of the tissue surrounding the wound or a Z-swab of the torso(on day 28 and 56)