Journal of Cutaneous and Aesthetic Surgery

INNOVATIONS
Year
: 2021  |  Volume : 14  |  Issue : 3  |  Page : 362--363

Bridging the gap: Innovative use of disposable syringe and platelet-rich fibrin for treating planter fissures


Vikas Pathania1, Siddharth Bhatt2,  
1 Department of Dermatology, Command Hospital, Pune
2 Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India

Correspondence Address:
Lt Col (Dr) Vikas Pathania
Department of Dermatology, Command Hospital (SC), Pune 411040, Maharashtra.

Abstract

Deep plantar fissures are a common, painful condition, which are often recalcitrant to multiple modalities. Autologous platelet-rich fibrin is a reservoir of supraphysiological concentration of platelets housing various growth factors shown to accelerate wound healing. This unique form factor affords a novel advantage of its ability to be applied over and within these fissures under occlusion. We report the innovative use of disposable syringes to fashion platelet-rich fibrin casts for management of these deeper fissures.



How to cite this article:
Pathania V, Bhatt S. Bridging the gap: Innovative use of disposable syringe and platelet-rich fibrin for treating planter fissures.J Cutan Aesthet Surg 2021;14:362-363


How to cite this URL:
Pathania V, Bhatt S. Bridging the gap: Innovative use of disposable syringe and platelet-rich fibrin for treating planter fissures. J Cutan Aesthet Surg [serial online] 2021 [cited 2022 Jan 24 ];14:362-363
Available from: https://www.jcasonline.com/text.asp?2021/14/3/362/328665


Full Text



 Introduction



Plantar fissures are a common and ubiquitous condition. The pathogenesis of plantar fissure is likened to the formation of vertical cracks in a barrel due to hoop stresses combined with dryness. This in addition to lack of cohesion in the corneocytes in case of keratinization disorders like ichthyosis leads to the formation of large extensive painful fissures refractory to treatment severely impairing the quality of life of the individual. Sivakumar et al.[1] have graded plantar fissures as Grade 1: superficial painless fissures involving proximal half of foot, Grade 3: painful deep fissures involving whole of foot, and Grade 2 (fissuring condition between Grades 1 and 3). Management options are limited and often unsatisfactory including topical keratolytics and occlusion with micropore tape for Grades 1 and 2.[2] However, deeper, painful, and bleeding fissures (Grade 3) tend to be recurrent and recalcitrant to these modalities.

 Innovation



We made a novel innovation for treating deep fissures (Grade 3) with platelet-rich fibrin (PRF). This was done by loading a 10-mL syringe with freshly prepared PRF and pushing it with pressure through the nozzle devoid of the needle to fashion slender tubular casts. These tubular casts of PRF hence obtained were used to snugly plug these deeper fissures under occlusion by securing with multilayered occlusive dressing comprising of a hydrogel (INTRASITE, Smith & Nephew Healthcare Pvt. Ltd.), surgical gauze, and elastic adhesive bandage [Figure 1]. Complete resolution of the fissures was noted with four sessions of instilling PRF in this way [Figure 2]. Platelet-rich plasma (PRP) and more recently PRF are being increasingly used in wound healing and nonhealing ulcers. PRF scores over PRP in this regard for many reasons. There is a sustained release of cytokines from PRF in wound milieu over a week rather than sudden short-lived release in the case of PRP. Second, the integration of fibrin network into the regenerative sites aids in cellular migration of the endothelial cells, which helps in neo-angiogenesis. Third, the presence of leukocytes in the fibrin network helps in evading infections as evidenced by its antimicrobial properties. Fourth, the PRF spun at a lower speed minimizes trauma to individual cells, thereby ensuring more stem cells in the final product. Lastly, the method of preparation is much easier than PRP and does not require the addition of any additional material like anticoagulant making it a true autograft.[3] The innovation highlights a novel modality in the management of deep and painful plantar fissures with a disposable syringe and PRF.{Figure 1} {Figure 2}

 Limitation



The temporary and delicate nature of the dressing renders itself to inconsistencies in results and recurrent sessions require multiple patient visits.

 Conclusion



The innovation highlights the use of autologous PRF as a novel, cheap, and effective modality in treating deep plantar fissures.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Sivakumar M, Sivapriya N, Mathew AC, Chacko TV, Srinivas CR. Prevalence and correlates of fissure foot in a rural area in Tamil Nadu. Indian J Dermatol Venereol Leprol 1999;65:26-7.
2Lakshmi C, Srinivas CR, Mathew AC. Treatment of fissure soles with occlusion using micropore tapes. Indian J Dermatol 2007;52:150-2.
3Pravin AJ, Sridhar V, Srinivasan BN. Autologous platelet rich plasma (PRP) versus leucocyte-platelet rich fibrin (l-PRF) in chronic non-healing leg ulcers: a randomised, open labelled, comparative study. J Evol Med Dent Sci 2016;5:7460-2.