Platelet Rich Fibrin Treatment
Platelet Rich Fibrin
What is the difference between platelet rich fibrin (PRF) and how does it differ from platelet rich plasma (PRP) and fibrin glue (Tisseel)?
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Up to this point, platelet-rich plasma (PRP) has been the only platelet-based product offered for treatment of damaged tissue. More recently, platelet-rich fibrin (PRF) has emerged as a more advanced and effective product in the world of musculoskeletal care. Medical research has shown many key nutrients and proteins that are embedded within the PRF network, such as blood-extracted mesenchymal stem cells, leukocytes, VEGF (vascular endothelial growth factors), MMP (matrix metalloproteinase)-1 and -8. The new PRF-based matrices are known to play an important role in the process of wound healing and new tissue formations.
Although there are some basic similarities between platelet-rich plasma and platelet-rich fibrin, it is the differences between these two products that makes platelet-rich fibrin stand out as a superior treatment option for spinal disc disease and damage of the spinal disc annulus. Both of these products require blood to be withdrawn. PRP requires more blood to be taken than PRF. Both of the biologics require the entire blood sample to be placed into a centrifuge, where the blood is then processed to help separate the it into distinct layers. Platelet-rich plasma is spun at a higher speed, which effectively causes all of the heavier cells in the blood (white blood cells) and stem cells to collect at the bottom of the test tube and allows for the lighter platelets and plasma to collect at the top layer of the test tube. The platelets and plasma are then collected from the upper part of the test tube and injected into the area where there is tissue damage.
Newer research has now shown that platelet rich plasma (PRF) is a platelet product that has an even higher concentration of platelets (combined with a concentration of some white blood cells and stem cells) and is even MORE effective in the repair of damaged tissue than traditional platelet-rich plasma. This means there are MORE healing factors within platelet-rich fibrin than what is found in platelet-rich plasma. Additionally, the lower speed causes LESS trauma to the individual cells within the blood, which allows more stems cells to remain healthy and intact within the final platelet rich fibrin product.
Another distinct difference between PRF and PRP is the total concentration of platelets that are found in the final product. Literature states that an ideal concentration of platelets in a PRP sample is between two to five times the level of platelets typically found in the body. Newer research has now shown that an even HIGHER concentration of platelets may be even more effective in the treatment of tissue damage. It is important to note that the process of obtaining the right levels of platelet concentrations differ between male and female patients, since each gender has a specific red blood cell count, therefore the process of obtaining platelet rich fibrin is slightly different for both genders. Platelet-rich fibrin products contain TEN TIMES the platelet concentration that is found within the body. Another significant difference between PRF and PRP is that platelet-rich fibrin does not require an anticoagulant during the processing of the gathered blood sample. Platelet-rich plasma requires an anticoagulant (acid citrate dextrose) to be added during the process, which prevents the blood from clotting too quickly. What this means is that without any additional anticoagulant added to the blood sample, this will allow for the natural fibrinogen in the blood to convert to fibrin by way of thrombin, in the earlier stages of clot formation. Thus, creating a spongy fibrin matrix which activates the platelets and allows for a slow release of growth factors, which then starts the tissue healing process in the damaged spinal disc annulus.
Human Fibrin Glue (HGF)
Human fibrin glue (HGF) products, such as Tisseel, are made of two components contained in separate vials: a freeze-dried concentrate of clotting proteins, mainly fibrinogen (lyophilized pooled human concentrate), Factor XIII and fibronectin (the sealant) and freeze-dried thrombin (the catalyst). The first component is reconstituted with an aprotinin solution that inhibits tissue fibrinolysis. The second component, thrombin (bovine sourced), available in 500 IU concentration, is dissolved with calcium chloride. Thrombin is an enzyme and converts fibrinogen into fibrin monomers between 10 and 60 seconds. It is this set of substances involved in the hemostatic process and in the wound healing, that are applied to a site of tissue damage to glue them together. Thus, giving rise to a three-dimensional gel compound.
Fibrin glue is composed of two separate foreign products, including donor blood products for the fibrin component and bovine (cow) blood products for the thrombin component. In contrast, platelet-rich fibrin (PRF) uses a patient’s OWN (autologous) blood products only.
Transplanted stem cells used in fibrin glue come from other persons and pigs, called donors. Donor transplant are called allogenic transplants. However, allogenic transplants may be less effective and may have more associated risks than autologous transplants because the cells of the donor and the recipient mix together, which can lead to graft versus host disease.
Factors that influence dimensional structure of fibrin gel giving rise to fine or coarse gel include the following:
- Changing the concentration of fibrinogen.
- Changing the concentration of thrombin-increased concentration increasing ultimate tensile strength and elastic modulus of gel.
- Changing the concentration of calcium.
A patient’s own fibrin (PRF) will have the persons own pH, temperature, and concentration of fibrinogen. Furthermore, PRF includes no added calcium products or bovine thrombin. PRF naturally treats spinal disc and spinal annulus disease by using a patient’s own allogenic fibrin, conferring a hemostatic and sealing action, through the strengthening of the last step of physiological coagulation and bio stimulation, which favors the formation of new tissue matrix.
What are the potential benefits of PRF?
Patients can see significant improvement in symptoms. This may help eliminate the need for more aggressive treatments, such as long-term medication or more invasive, permanent surgical procedures. It is a very simple in-office procedure that carries very low risks and complications. When compared to traditional PRP treatments, PRF is relatively painless, has a quicker healing time and shorter recovery period, and less blood is withdrawn.
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What to expect with platelet-rich fibrin
This is a minimally invasive procedure that can take up to two hours and is performed as an outpatient procedure. The patient will receive local anesthetic and has the option of mild intravenous conscious sedation to ensure maximum comfort during the procedure. A sample of blood is taken and processed to concentrate fibrin, along with other anti-inflammatory and growth factors. Then using fluoroscopic (x-ray) guidance, this concentrated solution is carefully injected into the damaged area. The fibrin and growth factors combine to facilitate healing and new tissue growth.
It is normal to be sore for a few days after the procedure. The level of discomfort and recovery times are minimal and significantly less than what one would experience after a more invasive surgery, such as spinal fusion surgery. You will have some downtime that could range from a few days to several weeks, depending on your condition and level of treatment needed.
Let us help you to get your life back. A good treatment plan can help to relieve your discomfort and return you to a pain-free and active lifestyle. Cell Bionics Institute offers a comprehensive spine functional restoration program to help patients with all of their spine care needs. With every treatment, we work to help with your current health situation, while also keeping your future health in consideration. The Biodisc® procedure is a much less invasive option, with a much more shortened recovery period than a more invasive procedure, such as spinal fusion surgery. See if you might be a candidate for Biodisc® today. Request a consultation with a spine care expert to discuss a treatment customized treatment plan to help with your back pain.
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