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

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.