PRP Protocol

• Only for injection in skin rejuvenation.

 With 2cc sample (BC + plasma) is enough to apply the full face
 Use the needle of 27 G to 31G with 1 to 2 mm depth
 Each point of application put 0.1 ~ 0.2 cc of prp ozonized
 Application point distance: 0.5 to 1cm
 The remaining plasma after procedure can apply in the face, let stand for
half and hour and then rinse with warm water.

Recommendations and contraindications:

 During the 7 days prior and after the application of PRP : should not consume an-
tiplatelet drug, aspirin and analgesic.
 Stop the deterioration of the tissues and skin
 The rejuvenation is deep and lasting working from the cells which reflected on the
outside
Frequently Asked Questions – PRP
• When is recommend the application of PRP?
 From 30 years old

• How many times of section is necessary?

 The protocol with PRP is specific for each patient in grade of
function of aging and the feature of his skin

• When can see the results?

 Since the early days and a max. 20~30 days,
 And the results of the last meeting with PRP takes about 1 year.

• Advantages with respect over other treatments

 Adverse effects are discarded
 Avoiding the risk of infection of diseases and allergic reactions.
ACNE SCAR female 30 years old.

before 10 weeks after PRP

before 3 month after PRP
Medicine (Clinical) – Indication of PRP
Therapy

• Plastic Surgery
 Skin graft, skin defect, foot ulcer, burn

• Orthopedics
 Non-union, intraoperative PRP injection
 osteoarthritis

• Sport medicine
 Regeneration of Tendon and ligament injury
Tendinosis
Acute and chronic muscle strain
Ligamentous sprain
Joint capsular laxity
Shoulder
1.Rotator cuff tendon, impingement
2. ant. & post band of the IGHL
3. ACJ, SCJ and C-C ligament
4. SLAP lesion

Elbow
1. Lateral epicondylitis
: ECRB, ECRL, annular ligament,
collateral ligament
2. Medial epicondylitis
: common flexor tendon,
collateral ligament
Wrist and Hand
1. Wrist ligaments
2. TFCC
3. De Quervain’s disease (chronic)
4. Finger ligament and tendons
Spine & Pelvis
• SIJ, Facet joint,
• iliolumbar ligament
• pelvis ligaments

Hip
• Hip joint : impingment, arthritis
• Ligaments of hip
iliofemoral - ant. capsule
pubofemoral
ischiofemoral : post capsule
• hamstrings
Knee
• Cartilage : osteoarthritis, chodromalacia patellae
• Meniscus : medial/lateral meniscus
• Ligament : MCL, LCL, ACL, PCL
• Tendon : patellar, quadriceps, Pes anserinus

Ankle & Foot

Ankle ligament (ATFL ect..)
Ankle joint
plantar fasciitis
Achilles tendinopathy
PRP can enhance Osteoarthritis symptoms
Knee Surg Sports Traumatol Arthrosc April 2009
Platelet-rich plasma: intra-articular knee injections
produced favorable results on degenerative cartilage lesions
E Kon et al : Rizzoli Orthopaedic Institute, Bologna, Italy

 PRP intra-articular injections (100pts ; 115 knees)

 Inclusion criteria ;
 chronic (at least 4 months) pain or swelling of the knee
 imaging findings of degenerative changes in the joint.
 Severity
 degenerative chondral lesion (Kellgren 0) : 58
 early osteoarthritis (Kellgren I–III) : 33
 advanced osteoarthritis (Kellgren IV) : 24
 Injection : 3 times injection, 21days interval
 Functional Index evaluation before, end of Tx,
6 and 12 months FU (IKDC,objective and subjective, and EQ VAS)
Osteoarthritis of Knee
Intraartcular Injection methods

1) Lateral approach
- Most commonly used
- Lines are drawn along the lateral and proximal borders of the patella. The
needle is inserted into the soft tissue between the patella and femur near
the intersection point of the lines and directed at a 45-degree angle
toward the middle of the medial side of the Joint

2) Medial approach
The needle enters the medial side of the knee under the middle of the
patella (midpole) and is directed toward the opposite patellar
midpole

3) Anterior Approach
- Position : knee flexed at 60° to 90
- Insert the needle into the space between the patella and femur parallel to the
middle facet of patella and tibialplateau (angle the needle to the center of the
patella)
– Distance from skin to the articular surface of the femoral condyle : 4.5-5.5 cm
Contraindication
• Absolute Contraindication
- Platelet dysfunction syndrome
- Critical thrombocytopenia
- Hypofibrinogenemia
- Hemodynamic instability
- Septicemia
• Relative contraindication
- Consistent use of NSAID’s within 7 days (before and after) of procedure
- Corticosteroid injection at treatment site or systemic use of
corticosteroids within 2 weeks of graft procedure
- Recent fever of illness
- Rash at graft donor site or at receptor site
- Cancer history of Pseudomonas, Enterococcus, Klebsiella infection
- Hb < 10g/dl
- Platelet count less than 105 / ul
Risks

• 1:50,000 chance of infection

• Allergy to local anesthetics
• Syncope with pain
• Injury occurrence with numbness or pain following
procedure
• Though extremely rare, pain or function may worsen
• Puncture of tissue outside of intended graft site
 Effectiveness of PRP

Healing process of wound Reduce of Pain

100 100
PRP Treatment
Recovery of Wound %

Ordinary treatment
Ordinary treatment

Painful (Patient)
PRP treatment
0 0

0 Physiological process 30 days 0 Physiological process 30 days

Journal of Oral & Maxillofacial Surgery, 2000; 58:45 Marx, Monteleone, Ghurani, Dr. Robert Marx, University of Miami