Postoperative wound healing is a crucial determinant of recovery following open abdominal surgeries. Despite advances in surgical techniques and aseptic measures, complications such as delayed healing, wound dehiscence, and surgical site infections (SSI) continue to affect a significant proportion of patients, especially in high-risk groups with comorbidities such as diabetes, obesity, or malnutrition (1,2). The need for innovative, biologically active interventions to enhance tissue regeneration and minimize healing time is therefore evident.

Platelet-rich plasma (PRP) has emerged as a potential therapeutic option to accelerate wound healing due to its high concentration of platelets and associated growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF) (3,4). These bioactive molecules play pivotal roles in cell proliferation, angiogenesis, and tissue remodeling during the various phases of wound repair (5).

The use of PRP in surgical settings has gained popularity across disciplines such as orthopedics, maxillofacial surgery, and dermatology, where studies have demonstrated its beneficial effects in enhancing soft tissue and bone healing (6,7). However, literature focusing specifically on the role of PRP in the healing of abdominal surgical wounds remains limited, with inconsistent results and a lack of standardized protocols for its preparation and application (8,9).

Given the biological plausibility of PRP in promoting tissue regeneration and the growing interest in autologous regenerative therapies, this study was undertaken to assess the effectiveness of topical PRP in enhancing postoperative wound healing in patients undergoing open abdominal surgeries. The study also aimed to evaluate its impact on wound infection rates and patient satisfaction compared to conventional wound care protocols.

Study Design and Setting

This prospective, randomized comparative study was carried out at the Department of General Surgery in Travancore Medical College, Kollam, Kerala over a 12-month period. The study received approval from the Institutional Ethics Committee, and informed consent was obtained from all participants prior to enrollment.

Sample Size and Grouping

A total of 60 patients undergoing elective open abdominal surgeries were enrolled. They were randomly assigned into two equal groups using a computer-generated randomization table. Group A (n=30) received conventional postoperative wound care, while Group B (n=30) received topical platelet-rich plasma (PRP) application in addition to standard wound management.

Inclusion and Exclusion Criteria

Inclusion criteria consisted of adult patients aged between 18 and 65 years, undergoing clean or clean-contaminated open abdominal surgeries. Patients with uncontrolled diabetes mellitus, immunosuppression, active systemic infections, bleeding disorders, or on anticoagulant therapy were excluded from the study.

Preparation of Platelet-Rich Plasma (PRP)

Autologous PRP was prepared intraoperatively under sterile conditions using a two-step centrifugation method. Approximately 20 mL of the patient’s venous blood was collected in anticoagulant-containing tubes and centrifuged at 1500 rpm for 10 minutes to separate the plasma. The plasma was then subjected to a second spin at 3000 rpm for 10 minutes to concentrate the platelets. The lower third of the resulting plasma layer, rich in platelets, was aspirated and used for topical application.

Surgical Procedure and Application of PRP
All patients underwent standard open abdominal procedures under general anesthesia. Upon closure of the fascia and prior to skin suturing, Group B patients received 3–5 mL of freshly prepared PRP applied topically to the wound bed. In Group A, no PRP was applied. Skin closure was performed in a similar manner in both groups using non-absorbable interrupted sutures.

Postoperative Follow-up and Assessment

Wound assessment was carried out on postoperative days 3, 7, and 14. Parameters evaluated included the rate of epithelialization, wound discharge, signs of infection, and pain at the surgical site. The Southampton wound grading system was employed to objectively assess healing outcomes. Surgical site infections (SSIs) were diagnosed based on CDC guidelines. Patient-reported satisfaction scores were obtained on day 14 using a 5-point Likert scale.

Statistical Analysis

Data were analyzed using SPSS software version 26. Continuous variables were presented as mean ± standard deviation and compared using Student’s t-test. Categorical variables were compared using the chi-square test or Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant.

A total of 60 patients were included in the final analysis, with 30 patients each in Group A (control) and Group B (PRP-treated). Both groups were comparable in terms of demographic and baseline clinical characteristics (Table 1).

Wound Healing Status

By postoperative day 14, a higher proportion of patients in the PRP group achieved complete epithelialization compared to the control group. Specifically, 26 patients (86.7%) in Group B demonstrated complete healing, whereas only 19 patients (63.3%) in Group A had similar outcomes (p = 0.032) (Table 2).

Incidence of Surgical Site Infection (SSI)

The incidence of surgical site infections was significantly lower in the PRP group, with only 2 patients (6.7%) developing SSIs, compared to 6 patients (20%) in the control group (p = 0.041) (Table 2).

Time to Healing

The average time taken for complete wound healing was markedly reduced in the PRP group (mean: 9.1 ± 1.3 days) in comparison to the control group (mean: 12.5 ± 2.2 days), with a statistically significant difference (p < 0.001) (Table 3).

Patient Satisfaction Scores

Patient satisfaction scores, measured on a 5-point Likert scale, were also higher in the PRP group (mean: 4.6 ± 0.4) than in the control group (mean: 3.9 ± 0.5), and this difference was statistically significant (p = 0.015) (Table 3).

Table 1: Baseline Demographic and Clinical Characteristics of Study Participants

Table 2: Wound Healing Outcomes and Infection Rates

Table 3: Healing Time and Patient Satisfaction

The findings of this study support the hypothesis that topical application of platelet-rich plasma (PRP) significantly enhances postoperative wound healing in patients undergoing open abdominal surgeries. Patients in the PRP-treated group demonstrated faster wound closure, lower infection rates, and higher satisfaction scores compared to those receiving standard care. These results are in line with previously published literature supporting the regenerative potential of PRP in surgical wound management.

PRP contains a high concentration of platelets and associated growth factors such as PDGF, TGF-β, VEGF, and EGF, which play pivotal roles in all phases of wound healing, including inflammation, proliferation, and remodeling (1,2). The observed acceleration in healing time and improved epithelialization in the PRP group can be attributed to these bioactive components that stimulate angiogenesis, fibroblast proliferation, and extracellular matrix deposition (3,4).

Enhanced granulation tissue formation and reduced healing time was observed with PRP application in animal wound models (5). Moreover, in a clinical trial involving diabetic ulcers, PRP therapy resulted in a significantly higher rate of wound closure compared to conventional dressing methods (6). The present study extends this evidence to postoperative wounds in abdominal surgeries, a domain where limited data currently exists.

A noteworthy observation was the reduction in surgical site infection (SSI) rates among patients receiving PRP. PRP has been shown to exhibit antimicrobial properties due to the presence of leukocytes and specific peptides like thrombocidins, which inhibit microbial growth (7,8). This supports the findings where it was documented a decrease in infection-related complications when PRP was applied prophylactically in orthopedic procedures (9).

PRP application improved wound healing outcomes following sternotomy in cardiac surgery patients (10). Furthermore, PRP has demonstrated favorable outcomes in plastic and reconstructive surgeries, especially in skin graft donor sites and flap healing (11,12). The consistent findings across multiple surgical specialties point to PRP's broad applicability in enhancing soft tissue repair.

Patient satisfaction was higher in the PRP group, possibly due to reduced postoperative discomfort, faster recovery, and better cosmetic outcomes. An earlier study by Gentile et al. in aesthetic procedures also highlighted improved patient-reported outcomes when PRP was incorporated into treatment protocols (13).

Despite these promising results, there are limitations. The sample size, while adequate for preliminary evaluation, was relatively small. Larger multicentric trials with long-term follow-up are required to validate the routine use of PRP in abdominal surgeries. Additionally, the preparation and application protocols for PRP are not standardized globally, leading to variability in outcomes across studies (14,15).

In summary, the current study reinforces the clinical potential of PRP in promoting postoperative wound healing in open abdominal surgeries. The findings suggest that PRP can be a valuable adjunct in surgical wound care protocols, potentially reducing complications and enhancing recovery.

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