ORIGINAL ARTICLE

A new innovation in topical diabetic foot ulcer; hyaluronic acid platelet-rich fibrin (HAPRF) gel - a study in inflammation and angiogenesis

Ronald W. Kartika, Idrus Alwi, Em Yunir, Sarwono Waspadji, Saptawati Bardosono, Suzzana Immanuel, Todung Silalahi, Saleha Sungkar, Jusuf Rachmat, Franciscus D. Suyatna, Mirta Hediyati Reksodiputro

Ronald W. Kartika
Doctoral Program in Medical Science Faculty of Medicine Universitas Indonesia

Idrus Alwi
Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Em Yunir
Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Sarwono Waspadji
Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Saptawati Bardosono
Department of Nutrition, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

Suzzana Immanuel
Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Todung Silalahi
Department of Internal Medicine, Krida Wacana Christian University, Jakarta, Indonesia.

Saleha Sungkar
Department of Clinical Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

Jusuf Rachmat
Department of Thoracic Cardiac and Vascular Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

Franciscus D. Suyatna
Department of Clinical Pharmacology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

Mirta Hediyati Reksodiputro
Departement Facial Plastic Reconstructive Division, Department of Otorhinolaryngology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Email: citamirta@yahoo.com
Online First: November 04, 2021 | Cite this Article
Kartika, R., Alwi, I., Yunir, E., Waspadji, S., Bardosono, S., Immanuel, S., Silalahi, T., Sungkar, S., Rachmat, J., Suyatna, F., Reksodiputro, M. 2021. A new innovation in topical diabetic foot ulcer; hyaluronic acid platelet-rich fibrin (HAPRF) gel - a study in inflammation and angiogenesis. Bali Medical Journal 10(3): 901-908. DOI:10.15562/bmj.v10i3.2317


Background: Indonesia ranks 6th out of ten countries with the highest number of diabetes patients. An increase followed this condition in the prevalence of diabetic foot ulcers by around 15%. This study demonstrated the ability of combination of Platelet Rich Fibrin (PRF) and Hyaluronic Acid (HA) to reduce inflammation in diabetic foot ulcer (DFU) healing.

Methods: In the baseline, all patients received the same treatment including wound debridement. There were 20 subjects divided into two groups; HAPRF and  PRF. A part of sample was processed into lysate and stored in -80oC. The rest is applied as a topical therapy in DFU base on intervention. We analyzed the inflammation using two methods; swab in DFU and fibrin gel of HAPRF or PRF and ELISA on day-3 and day-7. We also measure the granulation index by digital photograph and analyze use ImageJ at the same time.

Result: There were 20 diabetic patients with DFUs, performed analysis of  IL-6  lysate gel HAPRF decrease  significantly compare with PRF on day 3 (p= 0.038) and day-7 (p = 0.034). Granulation index evaluation, in HAPRF increase on day-3 (p = 0.043), day-7 (p = 0.049), and day-14 (p = 0.041).

Conclusion: A-PRF +HA  administration leads to reduce  IL-6 levels, and accelerated wound healing of DFUs patients. HAPRF  directly aids epithelialization and granulation index.

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