Clin Exp Otorhinolaryngol.  2014 Mar;7(1):47-52.

Favorable Vocal Fold Wound Healing Induced by Platelet-Rich Plasma Injection

• Woo SH
• Jeong HS
• Kim JP
• Koh EH
• Lee SU
• Jin SM
• Kim DH
• Sohn JH
• Lee SH

Abstract

OBJECTIVES
To introduce a new injection material for vocal fold diseases, which could be readily translated to clinical practice, we investigated the effectiveness of platelet-rich plasma (PRP) injection on the injured vocal fold in terms of histological recovery.
METHODS
Blood samples were drawn from New Zealand White rabbits and PRP was isolated through centrifugation and separation of the samples. Using a CO2 laser, we made a linear wound in the 24 vocal fold sides of 12 rabbits and injected each wound with PRP on one vocal fold side and normal saline (NS) on the other. Morphologic analyses were conducted at 2, 4, and 12 weeks after injection, and inflammatory response, collagen deposit, and changes in growth factors were assessed using H&E and masson trichrome (MT) staining and western blot assay.
RESULTS
PRP was prepared in approximately 40 minutes. The mean platelet concentration was 1,315,000 platelets/mm3. In morphological analyses, decreased granulation was observed in the PRP-injected vocal folds (P<0.05). However, the irregular surface and atrophic change were not difference. Histological findings revealed significant inflammation and collagen deposition in NS-injected vocal folds, whereas the PRP-injected vocal folds exhibited less (P<0.05). However, the inflammatory reaction and fibrosis were not difference. In western blot assay, increased amounts of growth factors were observed in PRP-injected vocal folds.
CONCLUSION
Injection of injured rabbit vocal folds with PRP led to improved wound healing and fewer signs of scarring as demonstrated by decreased inflammation and collagen deposition. The increased vocal fold regeneration may be due to the growth factors associated with PRP.

Keyword

Vocal fold; Scar; Wound healing; Growth factor; Platelet-rich plasma

MeSH Terms

Blood Platelets
Blotting, Western
Centrifugation
Cicatrix
Collagen
Fibrosis
Inflammation
Intercellular Signaling Peptides and Proteins
Lasers, Gas
Platelet-Rich Plasma*
Rabbits
Regeneration
Vocal Cords*
Wound Healing*
Wounds and Injuries*
Collagen
Intercellular Signaling Peptides and Proteins

Figure

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  Fig. 1 Preparation of autologous platelet-rich plasma (PRP). (A) Blood samples from auricular artery of each rabbit were collected. (B, C) Each blood sample was centrifuged resulting in the three following layers. (D) The PRP was then gently aspirated with another pipette and placed in a sterile tube.

• 

  Fig. 2 (A, B) Morphologic examination was performed using a nasal speculum and a direct endoscope. (C) Normal vocal folds of rabbit (arrow, vocal fold; *, arytenoid). (D) Vocal fold mucosa was injured bilaterally using a CO2 laser, and injected with platelet-rich plasma in right and injected with normal saline in left vocal fold.

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  Fig. 3 The platelet-rich plasma (PRP)-treated group showed a significant decrease in granulation tissue throughout the entirety of the injured vocal folds, but the irregular surface and atrophic change was not significant (red arrow, normal saline side; white arrow, PRP side). *P<0.05.

• 

  Fig. 4 Histological findings of platelet-rich plasma (PRP)-treated group and control group. PRP-treated side (B, D) and control side (A, C). There were no significant differences in the densities of fibrosis and inflammatory reaction between the control and PRP-treated groups. Histological finding of PRP-treated group in coronal plane. PRP-treated side (F, H) showed better wound healing with moderate collagen (stained blue) compared with control side (E, G) showed dense collagen deposit (stained blue). *P<0.05.

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  Fig. 5 Western blotting (A) and densitometric analysis (B). Expression of growth factors in platelet-rich plasma (PRP) treated group 14 days after surgery. Western blot showed strong expression of all tested growth factors in PRP treated group. TGF-β, transforming growth factor-beta; PDGF, platelet-derived growth factor; VEGF, vascular endothelial growth factor; EGF, epidermal growth factor.

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