Efficacy of Combining Hyaluronic Acid and Platelet-Rich Fibrin in Diabetic Foot Ulcer

Objectives: A chronic complication of type-2 diabetes mellitus (DMT-2) is Diabetic Foot Ulcer (DFU). The main treatment used in DFU is wound cleansing, followed by dressing the wound as a local control to increase tissue granulation and epithelialization. This study aims to compare the efficacy of the combination of Hyaluronic Acid with Platelet Rich Fibrin (HAPRF) and Platelet Rich Fibrin alone in DFU. Methods: We conducted a randomized controlled trial from July 2019 to April 2020. The study was approved by the Ethics Committee of the Faculty of Medicine of Universitas Indonesia ID 0855 / UN2.F1 / ETIK / 2018. Informed consent was obtained from the patients. This was a randomized clinical study to compare the efficacy of HAPRF and PRF in DFU one week post debridement. Twenty DFU samples were collected divided into 2 treatment groups: topical treatment using HAPRF compare with PRF alone. Assessment for wounds improvement was recorded using a digital camera 48 mega pixel with an accuracy of 0.1% on day-0, 3, 7, and 14. The results of the wound photographs were processed using ImageJ software. The granulation area (GA) and wound area (WA) were evaluated by IBM SPSS software v.20. The general data description was presented in median (range) value and parameter’s differences were conducted using Mann–Whitney test Results: The two treatment groups showed insignificant difference in characteristics between both group before intervention. The mean granulation width after two weeks of use HAPRF was 97.4% and PRF was 81.9%. Statistical analysis using Mann Whitney test showed granulation area of HAPRF group was significantly different compared with PRF group on day3(p=0.047) , day-7 ( p = 0.004) and day-14 ( p < 0.001). At the end of the wound healing process, the HAPRF group was significantly different compared with PRF group on ∆ day 0−3 ( p=0.048), ∆ day 0−7 ( p = 0.039), and ∆ day 0−14 ( p = 0.023). Conclusions: HAPRF improves wound healing rate through increasing granulation tissue and epithelialization compared with PRF only in diabetic foot ulcer after 2 weeks post debridement compared to PRF.