USE OF PRP IN RHINOPLASTY Dr. Dhafer Al Gerrah ENT Consultant – ALLCARE MEDICAL CENTER Abu Dhabi - UAE

DISCLAIMER The initiative of conducting this study, the views, opinion and reported out comes presented are based solely on my interest into the field. I do not have any financial benefits from any company distributing/supplying PRP kits or any drugs/medical equipment I do not intend to advertise any specific product and I am not financially rewarded for presenting this study as guest speaker . All the photo used in this presentation are displayed with the approval of the patients and along with all analysis and findings are my intellectual property

What is PRP? Platelets rich plasma. An autologous material. Easily prepared. Easily administered Beneficial in wound healing and rejuvenation

The growth factors and other cytokines present in PRP Platelets derived growth factor. Vascular endothelial growth factor. Insulin like growth factor 1 and 2 Fibroblast growth factor. Transforming growth factor beta. Epidermal growth factor. Interleukin 8. Keratinocyte growth factor. Connective tissue growth factor.

Phases of wound healing HAEMOSTATIC PHASE PROLIFERATIVE PHASE INFLAMATORY PHASE MATURATION PHASE

1) HEMOSTATIC PHASE Begin immediately after tissue injury. Platelets migrate and bring to the wound site. Fibrinogen Fibrin Thrombin Platelet/ fibrin structure is formed, growth factors are released from the platelet alpha-granule. Wound healing starts

PRP ADVANTAGES in hemostatic phase PRP increase plasma with fibrinogen and coagulation factors PRP increases platelets x 4 times Platelets with fibrin and without red cells form good clots Platelets release in about 1 minute GF and continue for about 1 week

2) PROLIFERATIVE PHASE Lasts 4-24 days. Granulation tissue fills in the wound Fibroblasts lay network of collagen in wound bed which gives strength to the tissue. Wound begins to contract and edges pull together. Epithelial cells from wound margins migrate inwards to cover the wound.

2) PRP ADVANTAGES in proliferative phase Release GF, chemotactic & mitotic substances Increase precursor cells

3) INFLAMATORY PHASE In this phase damaged and dead cells are cleared out, along with bacteria by process of phagocytosis by WBCs Platelet derived growth factor released into the wound results in migration and division of cells during proliferative phase

3 ) PRP ADVANTAGES in inflammatory phase Increases number of leucocytes and platelet inflammatory factors Stimulation of macrophages

4) MATURATION PHASE Lasts 21 days-2 years Begins when wound has filled in and resurfaced. Collagen fibers recognize, remodel, mature to give wound tensile strength forming scar tissue. Scar tissue is only 80% as strong as original tissue. The key cells in the healing process are macrophages & fibroblasts. Macrophages engulf and destroy bacteria and clean the wound site of debris. Fibroblasts synthesize collagen which is the principal component of the connective tissue.

4 )PRP ADVANTAGE maturation phase 1) Stimulates white blood cells and endothelial cells to produce other secondary growth factors. 2) Builds a 3rd matrix signal for differentiation. Results in faster and better healing.

PRP and infections platelet growth factors concentrated leukocytes, neutrophils, monocytes, and lymphocytes. Neutrophils and monocytes are rich in granules containing myeloperoxidase, which catalyzes the oxidation of chloride to generate hypochlorous acid and other reactive oxygen derivatives that act as potent bactericidal oxidants toxic to microorganisms and fungi. Platelets participate in antibody-dependent cell cytotoxicity functions to kill protozoal pathogens Platelet releases an array of potent antimicrobial peptides

Collagen matrix formulation Platelets release GF Fibrin Angiogenesis stimulated New blood vassels Scaffold for collagen process Fibroblasts migrate Collagen matrix formulation

STUDY INTRODUCTION Rhinoplasty is always associated with bruising nasal swelling nasal block and periorbital edema in the short postoperative period affecting quality of life of the patient badly. Platelets rich plasma (PRP) is claimed to fasten healing process reducing postoperative edema and bleeding!

METHODOLOGY How you did your study Prospective study 2 groups: Control Rhinoplasty without PRP. Study group Rhinoplasty with PRP Follow up for 3 months for primary outcomes looking at edema, bruises, nasal patency, nose bleeds.

STUDY DATA N=21 rhinoplasty cases CONTROL group ( w/o PRP ) STUDY group ( w/PRP) No of patients 8 13 Male 1 5 Female 7 Age 17 y.o-45 y.o 17y.o – 39 y.o W/septoplasty W/o septoplasty Primary 11 Revision 3 2 Open 9 Closed Osteotomy W/o Osteotomy

INJECTING PRP

Photo review on cases w/o PRP EEDEMA AND BRUISES Photo review on cases w/o PRP 48 hr – 5 days post op Male 23 y. o – w/o PRP 48 hr post - op 5 days post-op

Photo review on cases w/o PRP EDEMA AND BRUISES Photo review on cases w/o PRP 48 hr – 5 days post op Female 38 y. o – w/o PRP 48 hr post - op 5 days post-op

Photo review on cases w/o PRP EDEMA AND BRUISES Photo review on cases w/o PRP 48 hr – 5 days post op Female 17 y. o – w/o PRP 48 hr post - op 5 days post-op

Photo review on cases w PRP EDEMA AND BRUISES Photo review on cases w PRP 48 hr – 5 days post op Male 34 y. o – w PRP 7 days post - op 20 days post-op

Photo review on cases w PRP OEDEMA AND BRUISES Photo review on cases w PRP 48 hr – 5 days post op Male 26 y. o – w PRP 48 hr post - op 5 days post-op

Photo review on cases w PRP OEDEMA AND BRUISES Photo review on cases w PRP 48 hr – 5 days post op Female 33 y. o – w PRP 48 hr post - op 5 days post-op

Photo review on cases w PRP OEDEMA AND BRUISES Photo review on cases w PRP 48 hr – 5 days post op Female 32 y. o – w PRP 48 hr post - op 5 days post-op

Photo review on cases w PRP EDEMA AND BRUISES Photo review on cases w PRP 48 hr – 5 days post op Female 39 y. o – w PRP 48 hr post - op 5 days post-op

CONCLUSION 1. BLEEDING PATTERN 8hr – 48 hr Patient undergoing Rhinoplasty with PRP are: LESS LIKELY to experience moderate to severe bleeding in the next 8hr post surgery compared with those without PRP MORE LIKELY to have no bleeding after 48hr post surgery

CONCLUSION 2. PERIORBITAL OEDEMA 48hr – 5 days Patient undergoing Rhinoplasty with PRP are: LESS LIKELY to experience severe per orbital oedema within the first 48hr post surgery post surgery compared with those without PRP MORE LIKELY to have no per orbital oedema after 5 days post surgery

CONCLUSION 3. NASAL OEDEMA ( 5 days – 10 days post surgery ) Patient undergoing Rhinoplasty with PRP are: EQUALY LIKELY to experience mild to moderate NASAL OEDEMA within the first 5 days post surgery compared with those without PRP MORE LIKELY to experience faster reduction in NASAL OEDEMA over the 10 days post surgery compare with CONTROL GROUP ( rhinoplasty without PRP ). According to the findings the patient undergoing RHINOPLASTY without PRP do not have any reduction of edema at 10th days assessment compare with the 5th day assessment

CONCLUSION 4. BRUISES ( 8 hr./48 hr. / 5 days / 10 days ) Patient undergoing Rhinoplasty with PRP are: PLEASE COMMENT ON THE FINDNGS ? QUESTIONABLE….BRUISES have a better pattern for non PRP !!!!!

CONCLUSION 5 . NASAL PATENCY SUBJECTIVE VARIABLE IRRELEVANT OVER BOTH STUDY GROUPS SUBJECTIVE VARIABLE

CONCLUSION 6. NASAL PACKING For the last 2 patient ( Rhino with PRP ) I considered leaving in the nasal packs for 48hr. to assess the edema pattern. ( usually I remove them within the first 8hr post op ) OBSERVATION : edema subsided considerable at 5 days assessment, similar with cases with PRP and packs removed within first 8hr from surgery

Photo review on cases w PRP OEDEMA AND BRUISES Photo review on cases w PRP 48 hr – 5 days post op Female 33 y. o – w PRP 48 hr post - op 5 days post-op

Photo review on cases w PRP OEDEMA AND BRUISES Photo review on cases w PRP 48 hr – 5 days post op Female 39 y. o – w PRP 48 hr post - op 5 days post-op

Thank You