The use of platelet-rich plasma in the healing of chronic and hard-to-heal wounds – a systematic review
DOI:
https://doi.org/10.12775/JEHS.2026.88.68005Keywords
platelet-rich plasma, chronic wounds, hard-to-heal wounds, growth factors, wound healing, regenerative therapy, diabetic ulcersAbstract
INTRODUCTION: Chronic wounds are a significant clinical problem, burdening healthcare systems and affecting the quality of patients' life. The healing of chronic wounds is impaired at multiple levels, which makes traditional treatment methods often insufficient. Platelet-rich plasma is an autologous blood-derived preparation containing a high concentration of platelets and growth factors that can modulate regenerative processes in damaged tissues. OBJECTIVE: The objective of this review is to evaluate the efficacy and safety of using PRP in treatments of chronic and hard-to-heal wounds based on current clinical data. MATERIALS AND METHODS: A systematic search of the PubMed, Scopus, and Web of Science databases was conducted to identify clinical studies. Randomized controlled trials, cohort studies, case series, and systematic reviews published up to December 2025 were analyzed. Inclusion criteria included studies involving adult patients with chronic wounds, diabetic ulcers, pressure ulcers, venous ulcers, and hard-to-heal postoperative wounds. The following parameters were evaluated: wound healing time, rate of complete wound closure, reduction of wound surface area, pain intensity and the occurrence of adverse effects. KEY RESULTS: The analysis, covering 29 randomized clinical trials involving 2,198 chronic wounds, showed that the use of platelet-rich plasma significantly increased the chances of complete wound closure compared to standard treatment, with an odds ratio of 5.32 (95 percent CI: 3.37 to 8.40). Furthermore, PRP therapy was associated with a reduction in wound healing time by an average of 25 to 35 percent and a significant reduction in wound surface area. CONCLUSIONS: Platelet-rich plasma constitutes an effective and safe method supporting the treatment of chronic and hard-to-heal wounds. Its use can lead to the acceleration of the healing process, an increase in the rate of complete wound closure, and an improvement in the patients' quality of life.
References
1. OuYang H, Tang Y, Yang F, Ren X, Yang J, Cao H, Yin Y. Platelet-rich plasma for the treatment of diabetic foot ulcer: a systematic review. Front Endocrinol (Lausanne). 2023 Nov 18;14:1256081. doi: 10.3389/fendo.2023.1256081. PMID: 38169990; PMCID: PMC10760804.
2. Zanzov E, Anastasova V, Ivanova K, Kiskinov P. Platelet-Rich Plasma for Wound Healing in Diabetic Patients. Medicina (Kaunas). 2025 Aug 27;61(9):1535. doi: 10.3390/medicina61091535. PMID: 41010926; PMCID: PMC12472128.
3. Sen CK. Human Wounds and Its Burden: An Updated Compendium of Estimates. Adv Wound Care (New Rochelle). 2019 Feb 1;8(2):39-48. doi: 10.1089/wound.2019.0946. Epub 2019 Feb 13. PMID: 30809421; PMCID: PMC6389759.
4. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15;376(24):2367-2375. doi: 10.1056/NEJMra1615439. PMID: 28614678.
5. Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle). 2015 Sep 1;4(9):560-582. doi: 10.1089/wound.2015.0635. PMID: 26339534; PMCID: PMC4528992.
6. James GA, Swogger E, Wolcott R, Pulcini Ed, Secor P, Sestrich J, Costerton JW, Stewart PS. Biofilms in chronic wounds. Wound Repair Regen. 2008 Jan-Feb;16(1):37-44. doi: 10.1111/j.1524-475X.2007.00321.x. Epub 2007 Dec 13. PMID: 18086294.
7. Järbrink K, Ni G, Sönnergren H, Schmidtchen A, Pang C, Bajpai R, Car J. Prevalence and incidence of chronic wounds and related complications: a protocol for a systematic review. Syst Rev. 2016 Sep 8;5(1):152. doi: 10.1186/s13643-016-0329-y. PMID: 27609108; PMCID: PMC5017042.
8. Gottrup F. A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. Am J Surg. 2004 May;187(5A):38S-43S. doi: 10.1016/S0002-9610(03)00303-9. PMID: 15147991.
9. LaPrade RF, Geeslin AG, Murray IR, Musahl V, Zlotnicki JP, Petrigliano F, Mann BJ. Biologic Treatments for Sports Injuries II Think Tank-Current Concepts, Future Research, and Barriers to Advancement, Part 1: Biologics Overview, Ligament Injury, Tendinopathy. Am J Sports Med. 2016 Dec;44(12):3270-3283. doi: 10.1177/0363546516634674. Epub 2016 Mar 29. PMID: 27159318.
10. Blair P, Flaumenhaft R. Platelet alpha-granules: basic biology and clinical correlates. Blood Rev. 2009 Jul;23(4):177-89. doi: 10.1016/j.blre.2009.04.001. Epub 2009 May 17. PMID: 19450911; PMCID: PMC2720568.
11. Nurden AT, Nurden P, Sanchez M, Andia I, Anitua E. Platelets and wound healing. Front Biosci. 2008 May 1;13:3532-48. doi: 10.2741/2947. PMID: 18508453.
12. Andia I, Abate M. Platelet-rich plasma: underlying biology and clinical correlates. Regen Med. 2013 Sep;8(5):645-58. doi: 10.2217/rme.13.59. PMID: 23998756.
13. Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Król W, Wielkoszynski T. Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: an in vitro study. J Bone Joint Surg Br. 2007 Mar;89(3):417-20. doi: 10.1302/0301-620X.89B3.18491. PMID: 17356164.
14. Dhurat R, Sukesh M. Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective. J Cutan Aesthet Surg. 2014 Oct-Dec;7(4):189-97. doi: 10.4103/0974-2077.150734. PMID: 25722595; PMCID: PMC4338460.
15. DeLong JM, Russell RP, Mazzocca AD. Platelet-rich plasma: the PAW classification system. Arthroscopy. 2012 Jul;28(7):998-1009. doi: 10.1016/j.arthro.2012.04.148. PMID: 22738751.
16. Dimova A, Boroš M, Dimov S, Konjevod J, Svetec M. Platelet-rich plasma treatment for chronic wounds: A case report and literature review. World J Clin Cases. 2024 Nov 26;12(33):6635-6643. doi: 10.12998/wjcc.v12.i33.6635. PMID: 39600480; PMCID: PMC11514336.
17. Zanzov E, Anastasova V, Ivanova K, Kiskinov P. Platelet-Rich Plasma for Wound Healing in Diabetic Patients. Medicina (Kaunas). 2025 Aug 27;61(9):1535. doi: 10.3390/medicina61091535. PMID: 41010926; PMCID: PMC12472128.
18. Mohamadi S, Norooznezhad AH, Mostafaei S, Nikbakht M, Nassiri S, Safar H, Moghaddam KA, Ghavamzadeh A, Kazemnejad A. A randomized controlled trial of effectiveness of platelet-rich plasma gel and regular dressing on wound healing time in pilonidal sinus surgery: Role of different affecting factors. Biomed J. 2019 Dec;42(6):403-410. doi: 10.1016/j.bj.2019.05.002. Epub 2019 Dec 10. PMID: 31948604; PMCID: PMC6963006.
19. Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, Garcia J, Zaror C. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev. 2016 May 25;2016(5):CD006899. doi: 10.1002/14651858.CD006899.pub3. PMID: 27223580; PMCID: PMC9308064.
20. Ahmed AB, Thatcher S, Khorsandi J, Ahmed Z, Lee M, Jaouhari A, Bond B, Merchant A. Platelet-Rich Plasma (PRP) and Recombinant Growth Factor Therapies in Cutaneous Wound Healing: Mechanisms, Clinical Applications, and Future Directions. J Clin Med. 2025 Dec 3;14(23):8583. doi: 10.3390/jcm14238583. PMID: 41375885; PMCID: PMC12692824.
21. Wang Z, Feng C, Chang G, Liu H, Li S. The use of platelet-rich plasma in wound healing and vitiligo: A systematic review and meta-analysis. Skin Res Technol. 2023 Sep;29(9):e13444. doi: 10.1111/srt.13444. PMID: 37753680; PMCID: PMC10444946.
22. Yassin GE, Dawoud MHS, Wasfi R, Maher A, Fayez AM. Comparative lyophilized platelet-rich plasma wafer and powder for wound-healing enhancement: formulation, in vitro and in vivo studies. Drug Dev Ind Pharm. 2019 Aug;45(8):1379-1387. doi: 10.1080/03639045.2019.1620269. Epub 2019 Jun 4. PMID: 31099273.
23. Verma R, Kumar S, Garg P, Verma YK. Platelet-rich plasma: a comparative and economical therapy for wound healing and tissue regeneration. Cell Tissue Bank. 2023 Jun;24(2):285-306. doi: 10.1007/s10561-022-10039-z. Epub 2022 Oct 12. PMID: 36222966; PMCID: PMC9555256.
24. Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol. 2013 Dec;9(12):721-30. doi: 10.1038/nrrheum.2013.141. Epub 2013 Oct 1. PMID: 24080861.
25. Cavallo C, Filardo G, Mariani E, Kon E, Marcacci M, Pereira Ruiz MT, Facchini A, Grigolo B. Comparison of platelet-rich plasma formulations for cartilage healing: an in vitro study. J Bone Joint Surg Am. 2014 Mar 5;96(5):423-9. doi: 10.2106/JBJS.M.00726. PMID: 24599205.
26. Frykberg RG, Driver VR, Carman D, Lucero B, Borris-Hale C, Fylling CP, Rappl LM, Clausen PA. Chronic wounds treated with a physiologically relevant concentration of platelet-rich plasma gel: a prospective case series. Ostomy Wound Manage. 2010 Jun;56(6):36-44. PMID: 20567053.
27. Carter MJ, Fylling CP, Parnell LK. Use of platelet rich plasma gel on wound healing: a systematic review and meta-analysis. Eplasty. 2011;11:e38. Epub 2011 Sep 15. PMID: 22028946; PMCID: PMC3174862.
28. Putri AC, Soedjana H, Hasibuan L, Sundoro A, Septrina R, Sisca F. The Effect of Platelet Rich Plasma on Wound Healing in Pressure Ulcer Patient Grade III and IV. Int Wound J. 2025 Jul;22(7):e70458. doi: 10.1111/iwj.70458. PMID: 40667675; PMCID: PMC12265013.
29. Saldalamacchia G, Lapice E, Cuomo V, De Feo E, D'Agostino E, Rivellese AA, Vaccaro O. A controlled study of the use of autologous platelet gel for the treatment of diabetic foot ulcers. Nutr Metab Cardiovasc Dis. 2004 Dec;14(6):395-6. doi: 10.1016/s0939-4753(04)80029-2. PMID: 15853123.
30. Gentile P, Garcovich S. Systematic Review: Adipose-Derived Mesenchymal Stem Cells, Platelet-Rich Plasma and Biomaterials as New Regenerative Strategies in Chronic Skin Wounds and Soft Tissue Defects. Int J Mol Sci. 2021 Feb 3;22(4):1538. doi: 10.3390/ijms22041538. PMID: 33546464; PMCID: PMC7913648.
31. Torreggiani E, Perut F, Roncuzzi L, Zini N, Baglìo SR, Baldini N. Exosomes: novel effectors of human platelet lysate activity. Eur Cell Mater. 2014 Sep 22;28:137-51; discussion 151. doi: 10.22203/ecm.v028a11. PMID: 25241964.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Paulina Pawłowska, Szymon Piosik, Aleksandra Skorupa, Łukasz Piasecki, Natalia Dudziak, Marek Kochański
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 24
Number of citations: 0
