A new innovation in topical diabetic foot ulcer; hyaluronic acid platelet-rich fibrin (HAPRF) gel - a study in inflammation and angiogenesis

Background: Indonesia ranks 6th out of ten countries with the highest number of diabetes patients. An increase followed this condition in the prevalence of diabetic foot ulcers by around 15%. This study demonstrated the ability of combination of Platelet Rich Fibrin (PRF) and Hyaluronic Add (HA) to reduce inflammation in diabetic foot ulcer (DFU) healing. Methods. In the baseline, all patients received the same treatment including wound debridement. There were 20 subjects divided into two groups; HAPRF and PRE A part of sample was processed into lysate and stored in -80 degrees C. The rest is applied as a topical therapy in DFU base on intervention. We analyzed the inflammation using two methods; swab in DFU and fibrin gel of HAPRF or PRF and ELISA on day-3 and day-7.We also measure the granulation index by digital photograph and analyze use Image) at the same time. Result: There were 20 diabetic patients with DFUs, performed analysis of IL-6 lysate gel HAPRF decrease significantly compare with PRF on day 3 (p= 0.038) and day-7 (p = 0.034). Granulation index evaluation, in HAPRF increase on day-3 (p = 0.043), day-7 (p = 0.049), and day-14 (p = 0.041). Conclusion: A-PRF +HA administration leads to reduce IL-6 levels, and accelerated wound healing of DFUs patients. HAPRF directly aids epithelialization and granulation index.