They Were Going to Amputate This Finger Before PRP!
POSTED ON 5/4/2017 IN Hand and Wrist BY Christopher Centeno
Several months ago a patient I was seeing for another issue showed me the results of her finger-fusion surgery to treat arthritis. As she unwrapped her finger, I was a bit startled by its appearance (left above). It had the classic "mummy finger" dry-gangrene look, and her surgeon wanted to amputate it. She asked about whether PRP or stem cells could help, and I said I could try some PRP but I didn't have high hopes. I was wrong.
If finger joints hurt, especially at the tip of the finger, one possible solution is to insert a piece of metal and fuse the joint straight. This is a big surgery for a little joint and one of the possible complications is shown above. Basically, the tip of this patient's finger was dying.
How Could PRP Help?
By the time we began PRP, the patient's finger was in the nonhealing-wound stage. She had an open wound that was making no progress toward healing. The doctor wanted to amputate the end of the finger as the solution. How could PRP help?
PRP is short for platelet rich plasma, or concentrated platelets in plasma. These platelets can degranulate (release) growth factors that include VEGF, which can create new blood vessels. Often wounds aren't healing because there is a poor blood supply, so new blood vessels may help the wound heal. Other growth factors that are released include TGF-beta and FGF, which can help grow new tissue.
After the first PRP injection showed some healing, we were talking with the patient about injecting stem cells into the bone as despite a negative culture, the surgeon suspected an occult bone infection. However, we never had to go there. After a few PRP injections, the nonhealing wound closed, and she can now place weight on the finger in activities like yoga. So the amputation has been canceled!
The upshot? Regenerative medicine never ceases to amaze me. It's amazing that just a few injections of the right stuff prevented this woman from losing a chunk of her finger. The surgical community needs to stop practicing like it's 1985 and get on board the regen-med train, as now I wonder how many amputations don't need to happen!
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