Platelet gel as an intraoperatively procured platelet-based alternative to fibrin glue.

Sir: We enjoyed reading the article by Kulher et al. about the use of fibrin sealant in the prevention of seromas in a rat model ( Plast. Reconst). Surg. 99: 842. 199 7). We agree that the best managemeni of seromas is prevention. We would like to briefly describe the use of platelet gel as a wound sealant' and dural waterproofing agent that has been used successfully in numerous specialties at our institution for the past 18 months. Platelet gel is a platelet-based wound sealant that uses the concentrated platelets harvested by three-component centrifugal separation of autologous whole blood ( Medtronic Sequestra 1000 autotransfusion system, Parker, Colo.) to create a platelet concentrate intraoperatively. One unit of whole blond. approximatelc 450 nil • is drawn, either i n the bolding area or tile operating room. into a standard labeled blood collection bag containing , citrate-phosphatedextrose anticoagulant. The blood is centrifuged in the operating mom by using a dual-speed all auto tr ansfusion machine t o separate t he huffy coat suspended in 30 nil of plasma from t he reel blood cell pack and platelet-poor plasma fraction. This is t he platelet concentrate used for the platelet gel. Depending tin initial platelet counts, it is common to achieve platelet counts of 3110,1)00 t o I Million per from this three( component separation technique. Thc bard spin /soft spin technique used is similar to the method that the blood bank uses , to separate platelets front whole blond. The critical differences i n composition between platelet 1e • 1 and fibrin glue are the presence of a high concentration of platelets and a naive concentration of fibrinogen in platel et gel. We behove that platelet gel oilers significant advantages mere previouly described fibrinogen-based wound seal:nits. The inclusion of a buffy coat of plateletand Ieukocyte-enriched plasma appears to have several beneficial effects. With platelet counts of 500.000 to I million per nil, the various cytokines and mediators found in the platelet's alpha and densegranules can promote angiogenesis and collagen -sythesis . thereby enhancing soft-tissue wound healing. Clever mediators i nclude platelet-derived growth factor (PDGF) platelet-derived epidermal growth factor (PDEGF), fibroblast growth factor (FGF), transforming growth factorbeta (TGF-bi, and platelet-derived angiogenesis factor (PDAF).2-4 " Platelet-derived growth factor and transforming growth factor-beta have been found to increase the collagen content and earls rate of gain of strength in wounds." Plateletderived growth factor is known to be chemotactic for monocytes, macrophages , and fibroblasts : it is also an activator of collagenase within the later stages of wound healing. allowing l ot remodeling of collagen to promote wound strength. transforming growth factor-beta is known to activate fibroblasts to form procollagen that results in collagen deposition 1161