Soft and hard-tissue augmentation with platelet-rich plasma: Tissue culture dynamics, regeneration and molecular biology perspective

Platelet-rich plasma (PRP) has been extensively used in maxillofacial and oral surgery with predictable clinical outcomes. PRP has been used for hard and soft tissue regeneration. Anecdotal data indicate that PRP enhances the early wound-healing cascade by the interactions of activated platelet-released growth factors with the extra cellular matrix with potential potent anabolic affects. The processing of autologous PRP is highly variable and the types of propriety kits, centrifuges and vials available are numerous. Regarding facial rejuvenation and PRP, initial results are short-lived, inconsistent and further maintenance treatment is needed regarding facial wrinkle amelioration, as is the case with other fillers. It is not clear if "neocollagenesis" occurs after PRP rejuvenation therapy. Drawbacks of activated PRP, if used in the facial area, include the potential to micro-thrombosis in the region of the anterior facial vein, closed compartment syndrome and release of pro-inflammatory proteolytic activators from leucocytes. Compared to conventional culture mediums, unrefined and undiluted PRP may not be biologically suitable as a cell transport medium (i.e., for fibroblasts, keratinocytes and neural cells). Our ex vivo studies confirm potent TC mitogenic stimulation of human fibroblasts, keratinocytes, chondrocytes, neural tissue and myoblasts. There are no clinical reports of the application of PRP for repair of complex shoulder rotator cuff lesions. The authors describe the biology of platelet-rich plasma, potential application in dermal regeneration and rotator cuff surgery as an adjunct to conventional surgery for large or previous failed surgery, tissue physiological response to PRP and the molecular biology of PRP relevant to the shoulder surgeon.