Autologous Platelet Gel in Coronary Artery Bypass Grafting: Effects on Surgical Wound Healing

Advancements have been made in understanding the systematic processes of wound healing. Wound healing is traditionally explained in terms of three classic phases: inflammation, proliferation, and maturation (1). A clot forms and cells of inflammation debride injured tissue during the inflammatory phase. Epithelialization, fibroplasia, and angiogenesis occur during the proliferative phase; additionally, granulation tissue forms and the wound begins to contract. Collagen forms tight cross-links to other collagen and with protein molecules, therefore increasing the tensile strength of the scar during the maturation phase. During the inflammatory phase, the body rushes many cell types to the wound. Platelets are the first cell components to invade the wound site and initiate the wound healing process. Initially, hemostasis and cross-linked fibrin formation occur. Platelet degranulation leads to the release of growth factors (GFs) and cytokines, which play a major role in the recruitment and activation of neutrophils and macrophages (2). Platelet-derived growth factor, transforming growth factor, epidermal growth factor, and insulin-like growth factor are examples of GFs, which function to assist the body in repairing itself and stimulate new tissue regeneration (3). Major benefits of GFs include enhanced angiogenesis, improved bone regeneration, enhanced wound strength, and reduction in infection. With multi-component pheresis and the evolution of new sequestering devices, these two elements have helped to concentrate platelets from smaller blood samples instead of the traditional one-unit phlebotomy. The ability to collect platelet-rich plasma (PRP) has allowed clinicians to use the healing properties of platelets. Specialties such as plastic and reconstructive and orthopedic have used PRP because of their ability to deliver a plethora of GFs (4,5). The application of activator reagents such as thrombin and calcium with PRP to form autologous platelet gel (APG) provides a release of concentrated wound healing GFs. Despite anecdotal use of APG in cardiac surgery to reduce or eliminate wound infection and accelerate healing, there is little evidence in literature to support the efficacy of APG on surgical wound healing in cardiac procedures. The purpose of this study was to examine whether the application of APG on the sternum and saphenous vein harvest site was beneficial to patients undergoing coronary artery revascularization, in terms of pain, blood loss, discoloration, and surgical site infection (SSI).