The effect of platelet rich plasma on the structure of perioperative complications in patients with buccal flap urethroplasty

Abstract

The possibility of application of platelet-rich autoplasma in patients with an augmentation urethroplasty with buccal flap. It is found that patients treated with the closure of the bed of buccal mucosa with intraoperative administration of autologous platelet rich plasma in the area of the bed (group 4) had lower pain syndrome than patients treated without closure and without administration of autologous platelet rich plasma (group 1), patients only with sutured wounds of the cheek (group 2) and patients who underwent the administration of autologous platelet rich plasma without suturing of the buccal defect (group 3). The median pain intensity on the 2nd day was 3 points, on the 3rd day 2,6 points, on the 4th day of 1,9 points (p<0,001). Statistically significant differences among the 2nd, 3rd and 4th groups of up to the 4th day of observation are not revealed. On the 5th day in the 4th group, the median was 4,2 points, in the 1st group - 1,6 points, in the 2nd and 3rd groups - 3,3 points (p<0,001). Pairwise comparisons revealed statistically significant differences of pain in the 1st and 4th groups compared with the 3rd group (p<0,001 and p=0,007, respectively). In the figures between the 2nd and the 3rd groups the differences were insignificant (p=0,75). Difficulties in opening the mouth in the 1st day were observed in 21,9, and 11,7 to 21,2 and 14,7% for the 1st, 2nd, 3rd and 4th groups respectively (p=0,117). On the 5th day facial asymmetry was in 90,2, 51,4, of 90,9% and 47% patients of 1st, 2nd, 3rd and 4th groups respectively (p<0,001). By the end of the first week, the patients did not make any of the above-mentioned complaints. By the end of the first month, complaints on a decreased cheeks sensitivity remained with one person (3,2 per cent) from the 1st group and with one person (2,6 per cent) from the 2nd group (p=0,623). By the 6th month, the above-mentioned symptoms were absent. Thus, the use of autologous platelet rich plasma in combination with suturing of the defect of the inner surface of a cheek allowed to reduce postoperative pain by 2,5 times compared with patients without suturing the bed of a cheek and without the autologous platelet rich plasma administration.

Keywords

buccal flap / buccal graft / urethroplasty / pain / quality of life / complications / autoplasma / platelets

References

[1] Пат. № 2514639 Российская Федерация, МПК А61К35/162006.01. Способ лечения эректильной дисфункции / М.Е. Чалый, Я.Ф. Вилькин, М.В. Епифанова; опубл. 27.04.2014, БИ № 12. – С. 112–114.

[2] Синельников, Л.М. Аугментационная уретропластика свободными лоскутами при протяженных стриктурах передней уретры у мужчин / Л.М. Синельников [и др.] // Вестн. Росс. воен.-мед. акад. – 2012. – № 3 (39). – С. 29–33.

[3] Трухачева, Н.В. Математическая статистика в медико-биологических исследованиях с применением пакета Statistica / Н.В. Трухачева – М.: ГЭОТАР-Медиа, 2013. – 384 с.

[4] Фатхуллина, Л.С. Роль трансфузии концентрата тромбоцитов при кардиохирургических операциях / Л.С. Фатхуллина, Р.К. Джорджикия, И.М. Рахимуллин // Вестн. современной клин. мед. – 2014. – Т. 7, №. 5. – С. 56–58.

[5] Barbagli, G. Anterior urethral strictures / G. Barbagli, E. Palminteri, M. Lazzeri // B.J.U. Int. – 2003. – Vol. 92, № 5. – P. 497–505.

[6] Chapple, C. SIU/ICUD Consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty / C. Chapple [et al.] // Urology. – 2014. – Vol. 83, Suppl. 3. – P. 31–47.

[7] Dublin, N. Oral complications after buccal mucosal graft harvest for urethroplasty / N. Dublin, L.H. Stewart // B.J.U. Int. – 2004. – Vol. 94, № 6. – Р. 867–869.

[8] Gentile, P. The use of adipose-derived stromal vascular fraction cells and platelet rich plasma in regenerative plastic surgery / P. Gentile [et al.] // Stem Cells. – 2017. – Vol. 35, № 1. – Р. 117–134.

[9] Huang, Y. Platelet-rich plasma for regeneration of neural feedback pathways around dental implants: a concise review and outlook on future possibilities / Y. Huang Int. J. Oral Sci. – 2017. – Vol. 9, № 1. – Р. 1–9.

[10] Liddle, A.D. Platelet-rich plasma in the treatment of patellar tendinopathy: a systematic review / A.D. Liddle, E.C. Rodríguez- Merchín // Am. J. Sports Med. – 2014. – Vol. 43, № 10. – Р. 2583–2590.

[11] MacNab, I. Negative disc exploration: an analysis of the cause of nerve root involvement in sixty-eight patients // J. Bone Joint Surg. – 1971. – Vol. 53. – P. 891–903.

[12] Martinez-Zapata, M.J. Autologous platelet-rich plasma for treating chronic wounds / M.J. Martinez-Zapata [et al.] // Cochrane Database Syst. Rev. – 2016. – Vol. 5. – 68 р.

[13] Marx, R.E. Platelet-rich plasma: evidence to support its use / R.E. Marx // J. Oral Maxillofac. Surg. – 2004. – Vol. 62. – Р. 489–496.

[14] Mundy, A.R. Urethral strictures / A.R. Mundy, D.E. Andrich // BJU International. – 2011. – Vol. 107, № 1. – P. 6–26.

[15] Muruganandam, K. Closure versus nonclosure of buccal mucosal graft harvest site: A prospective randomized study on post operative morbidity // K. Muruganandam [et al.] //Indian J. Urol. – 2009. – Vol. 25, № 1. – Р. 72–75.

[16] Roh, Y.H. Cytokine-release kinetics of platelet-rich plasma according to various activation protocols / Y. H. Roh [et al.] // Bone Joint Res. – 2016. – Vol. 5, № 2. – Р. 37–45.

[17] Rourke, K. Effect of wound closure on buccal mucosal graft harvest site morbidity: results of a randomized prospective trial / K. Rourke, S. McKinny, B. St Martin // Urology. – 2012. – 79, № 2. – Р 443–447.

[18] Sínchez, M. Platelet-rich plasma, an adjuvant biological therapy to assist peripheral nerve repair / M. Sínchez [et al.] // Neural. Regen. Res. – 2017. – Vol. 12, № 1. – Р. 47–52.

[19] Santucci, R.A. Male urethral stricture disease / R.A. Santucci, G.F. Joyce, M. Wise // J. Urol. – 2007. – Vol. 177, № 5. – P. 1667–1674.

[20] Stacey, M.C. Randomised double-blind placebo controlled trial of topical autologous platelet lysate in venous ulcer healing / M. C. Stacey [et al.] // Eur. J. Vas. Endovasc. Surg. – 2000. – Vol. 20, № 3. – Р. 296–301.

[21] Weed, B. Autologous platelet lysate product versus placebo in patients with chronic leg ulcerations: a pilot study using a randomized, double-blind, placebo-controlled trial / B. Weed [et al.] / Wounds. – 2004. – Vol. 16, № 9. – Р. 273–282.

[22] Wood, D.N. The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain / D.N. Wood [et al.] // J. Urol. – 2004. – Vol. 172, № 2. – Р. 580–583.

[23] Wu, P.I. Platelet-rich plasma / P.I. Wu, R. Diaz, J. Borg-Stein // Phys. Med. Rehabil. Clin. N. Am. – 2016. – Vol. 27, № 4. – Р. 825–853.