Advance-Platelet Rich Fibrin and Hyaluronic Acid Combination Improves Interleukin-6 and Granulation Index in Diabetic Foot Ulcer Patients

Ronald Winardi Kartika (Doctoral Program in Medical Science, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Idrus Alwi (Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta)
Franciscus Dhyanagiri Suyatna (Department of Clinical Pharmacology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Em Yunir (Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta)
Sarwono Waspadji (Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta)
Suzanna Immanuel (Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta)
Todung Silalahi (Department of Internal Medicine, Krida Wacana Christian University, Jl. Arjuna Utara No.6, Jakarta)
Saleha Sungkar (Department of Clinical Parasitology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Jusuf Rachmat (Department of Thoracic Cardiac and Vascular Surgery, Faculty of Medicine ,Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Saptawati Bardosono (Department of Nutrition, Faculty of Medicine Universitas Indonesia, Jl. Salemba Raya No.6, Jakarta)
Mirta Hediyati Reksodiputro (Facial Plastic Reconstructive Division, Department of Otorhinolaryngology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta)

The Indonesian Biomedical Journal
Vol 13, No 2 (2021)

BACKGROUND: Diabetic foot ulcer (DFU) is the most common and threatening complication of Diabetes Mellitus (DM). Ideal wound dressing for DFU management should relieve symptoms, provide wound protection, and encourage healing. Advanced-Platelet Rich Fibrin (A-PRF) and Hyaluronic Acid (HA) have been proven to improve wound healing process. This study was aimed to demonstrate the ability of combination of A-PRF and HA in reducing inflammation and improving DFU tissue healing.METHODS: Twenty DFU subjects were involved in this study, and divided into two groups based on the topical fibrin gel treatment: A-PRF + HA group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. A-PRF + HA was prepared by homogening A-PRF and AH with a ratio of 1:0.6. Interleukin-6 (IL-6) level, granulation index (GI), numeric pain score (NPS), and inflammation clinical symptoms (ICS) were assessed on day-0, 3, 7 and 14.RESULTS: Wound swabs’ IL-6 level on day-7 was found to be significantly lower in A-PRF + HA compared to A-PRF alone (p=0.041). The IL-6 level reduction also found to be significant higher either in wound swabs (day 0-7, p=0.015) or fibrin gel (day 0-3, p=0.049; day 0-7, p=0.034). A-PRF + HA treatment significantly increased the GI even since day-3 (p=0.043), with lower NPS (p<0.001), and ICS score.CONCLUSION: The combination of A-PRF and HA increases the GI in DFU healing by reducing the inflammation state which will induce the angiogenesis process, as well as reducing pain in DFU subjects better than A-PRF alone.KEYWORDS: inflammation, interleukin-6, wound healing, angiogenesis, proliferation