Role of Leukocyte–Platelet-Rich Fibrin in Endoscopic Endonasal Skull Base Surgery Defect Reconstruction

摘要

Autologous platelet-rich preparations and fibrin glue technologies have been used for many years to promote surgical site healing.123 In 1970, Matras1 first described the use of fibrin glue resulting in improved wound healing in a rat model. This fibrin glue represents one of the first regenerative techniques ever developed and served as the foundation for investigation of the fibrin matrix to promote healing.14Over time, the focus of scientific inquiry has shifted toward the healing properties of platelets concentrated in the fibrin network. Subsequently, the value of circulating growth factors and leukocytes has become evident.235 It is currently accepted that all these elements play a significant role in the healing process. Fibrin, platelets, growth factors, leukocytes, and other cells play a major role in natural healing; therefore, to promote surgical site healing, all these components are combined in modern platelet-rich preparations.6The current classification of platelet-rich concentrates is based on their fibrin architecture and cell content. It consists of two main groups of products, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), both of which are available in a pure or leukocyte-enriched form (L-PRP and L-PRF).7 Each product has a unique biological profile that dictates its clinical applications. L-PRF concentrates provide slow release of many growth factors and can be easily prepared during surgery.89101112 They are inexpensive and autologous; therefore, they avoid the complications associated with allogenic blood use.Multiple surgical specialties have recognized the potential benefits of platelet-rich concentrates. Their use has been described in ophthalmology, neurosurgery, general surgery,13 orthopedic surgery, sports medicine,6 and oral and maxillofacial surgery.114 Several applications of L-PRF concentrate have been described in the literature including postoperative hand wound healing yielding faster reepithelization and in the treatment of androgenic alopecia diminishing hair loss among others.151617 To our knowledge, no studies have been conducted to investigate the effect of L-PRF on the healing of surgical defects following endoscopic skull base resections.Advancements in endoscopic endonasal approach (EEA) to skull base lesions have resulted in a significant increase in the extent and complexity of skull base defects, in turn, demanding more elaborate and novel reconstruction techniques to expedite healing and prevent postoperative reconstruction failures. The objective of this pilot study was to investigate the effects of L-PRF on postoperative healing of the sinonasal corridor and the rate of postoperative complications following endoscopic endonasal skull base surgery.