Platelet-Rich Plasma Gel Phonophoresis for Chronic Diabetic Foot Ulcers

Abstract

The purpose of the study: To explore the therapeutic effect of Platelet-Rich Plasma Gel Phonophoresis on wound healing in chronic diabetic foot ulcers.

Subjects and methods: Seventy-five patients suffering from chronic diabetic foot ulcers were randomly assigned into three equal groups, each group had 25 patients; their ages ranged from 45-65 years. The study group (A) received plasma gel phonophoresis in addition to the ordinary physical therapy program (offloading techniques, range of motion exercises, strengthening exercises as tolerated, balance and proprioception training, gait training, vascular/neuromuscular stimulation and patient education and self-care training) and medical treatment (glycemic control, wound care and infection prevention and management). Group B received ultrasound followed by applying topical platelet rich plasma (PRP) in addition to the ordinary physical therapy program and medical treatment. Group C received ultrasound in addition to the ordinary physical therapy program and medical treatment. Each patient received two sessions per week for six weeks. Evaluation procedures were carried out to evaluate ulcer area and depth using Image J software and cotton tip applicator respectively. The data were collected before and after the period of treatment for all groups.

Results: There was a significant decrease in ulcer surface area post treatment compared with pre-treatment in all groups (p < 0.001), with the greatest reduction observed in group A (MD=62.77%), followed by group B (MD=46.36%) and group C (MD=25.58%). Similarly, ulcer depth showed a significant decrease in post treatment compared with pre-treatment across all groups (p < 0.001). Group A demonstrated the largest improvement (MD=52.89%), followed by group B (MD=31.25%) and group C (MD=12.61%). There was a significant decrease in ulcer surface area and depth in group A and group B compared with group C post treatment (p < 0.01). In addition, there was a significant decrease in ulcer surface area and depth in group A compared with group B (p < 0.01).

Conclusion: Platelet-rich plasma gel phonophoresis was considered to be an effective modality for improving wound healing in subjects suffering from chronic diabetic foot ulcers.