Application of Topical Sucralfate and Topical Platelet-Rich Plasma Improves Wound Healing in Diabetic Ulcer Rats Wound Model

Renni Yuniati,1 Innelya Innelya,2 Arti Rachmawati,2 Harold Jefferson Matthew Charlex,2 Alfi Rahmatika,2 Matthew Brian Khrisna,1 Farmaditya EP Mundhofir,3 K Heri Nugroho Hario Seno,4 Tri Nur Kristina5 1Dermatology and Venereology Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia; 2Undergraduate Student, Faculty of Medicine, Diponegoro University, Semarang, Indonesia; 3Histology Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia; 4Internal Medicine Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia; 5Microbiology Department, Faculty of Medicine, Diponegoro University, Semarang, IndonesiaCorrespondence: Renni YuniatiDermatology and Venereology Department, Faculty of Medicine, Diponegoro University, Semarang, IndonesiaTel +628122874008Email renniyuniati@yahoo.comPurpose: One of the most serious and devastating complications of diabetes mellitus is diabetic ulcers. They are difficult to treat and often result in limb loss. Topical sucralfate and platelet-rich plasma have the potential to improve the healing outcomes of chronic ulcers, including diabetic ulcers. This research aims to determine the effectiveness of sucralfate and platelet-rich plasma therapy for the improvement of diabetic ulcer wound healing.Patients and Methods: Ninety Wistar rats were used in this study and were classified into five groups. Four of the five groups were diabetic induced and were treated with topical sucralfate only, platelet-rich plasma only, combination of topical sucralfate and platelet-rich plasma, and diabetic control group which received standard therapy only. The non-diabetic control group did not receive any therapy. We observed macrophage amount, platelet-derived growth factor, vascular endothelial growth factor, and hypoxia-inducible factor as a biomarker. Rats were terminated after 7th and 14th days and were subjected to immunohistochemistry staining and examination.Results: We found that topical sucralfate and platelet-rich plasma increase macrophage levels, vascular endothelial growth factor expression and platelet-derived growth factor expression in diabetic wound cells. We also found a reduction in hypoxia inducible factor-1α expression. Combination of topical sucralfate and platelet-rich plasma for 14 days gave the most significant improvement in terms of wound healing compared to topical sucralfate or platelet-rich plasma alone.Conclusion: The combination of topical sucralfate and platelet-rich plasma therapy results in the best improvement in diabetic ulcer wound healing compared to sucralfate or platelet-rich plasma monotherapy or conventional wound healing therapy.Keywords: hypoxia inducible factor, VEGF, PDGF, macrophag