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Recei ed: 22.08.2025. Re ised: 28.08.2025. Accep ed: 19.09.2025. Published: 25.09.2025.
THE ROLE OF PLATELET-RICH PLASMA (PRP) IN PEDIATRIC SURGERY AND
REGENERATIVE MEDICINE
T. R. Konyk, M. B. T okhymenko
I. Ho bache sky Te nopil Na ional Medical Uni e si y,
Minis y o Heal h o Uk aine, Te nopil, Uk aine
In o ma ion abou he au ho :
Konyk T.R. - 6 h yea s uden o he Facul y o Medicine, I. Ho bache sky Te nopil
Na ional Medical Uni e si y, Te nopil, Uk aine. ORCID ID: 0009-0004-3129-2381.
T okhymenko M.B. - 6 h yea s uden o he Facul y o Medicine, I. Ho bache sky
Te nopil Na ional Medical Uni e si y, Te nopil, Uk aine. ORCID ID: 0009-0008-1221-8943
Abs ac
Backg ound. Pla ele - ich plasma (PRP) is an au ologous plasma concen a e
con aining pla ele s, g ow h ac o s, and cy okines. I p omo es issue egene a ion by
accele a ing healing, educing in lamma ion, and enhancing eco e y. The use o an
au ologous sou ce minimizes he isks o immune ejec ion. PRP is pa icula ly aluable in
pedia ic su ge y, pa icula ly o enhancing issue egene a ion a e auma, co ec ing
congeni al anomalies, and imp o ing pos ope a i e healing, o e ing ad an ages whe e
adi ional me hods a e less e ec i e.
The aim. To analyze and summa ize da a on he e ec i eness o pla ele - ich plasma
(PRP) in issue egene a ion in pedia ic su ge y pa ien s. The s udy ocuses on he ole o
PRP in accele a ing wound healing, s imula ing bone egene a ion, and educing he isk o
pos ope a i e complica ions. The key objec i e is o e alua e he po en ial o PRP as an
2
adjunc o s anda d su gical echniques, pa icula ly bone g a s o econs uc ions, o i s
in eg a ion in o ou ine pedia ic p ac ice.
Ma e ials and me hods. The esea ch me hodology consis ed o a sys ema ic e iew
o scien i ic publica ions om he PubMed and ELSEVIER da abases om 2000 o 2024. The
selec ion c i e ia we e English-language a icles (clinical s udies and e iews) ha ocused on
he clinical applica ion o PRP o issue egene a ion in pedia ic su ge y (pa ien s unde 18
yea s o age). The analysis ocused on e alua ing he e icacy and sa e y o PRP in he
pedia ic popula ion.
Resul s. PRP ac s as a con olled deli e y sys em o bioac i e molecules, modula ing
in lamma ion, s imula ing cell p oli e a ion, angiogenesis, and ex acellula ma ix syn hesis.
G ow h ac o s eleased om α-g anules, such as PDGF, TGF-β, VEGF, and EGF, a e he
basis o egene a ion. In a andomized s udy o in an s wi h meningomyelocele, PRP gel
applied o he de ec si e signi ican ly educed ce eb ospinal luid leakage (5% s. 45%),
meningi is (0% s. 35%), pa ial skin nec osis (15% s. 65%), and wound dehiscence (15%
s. 35%; all p < 0.05). In ea ing pilonidal sinus in adolescen s, PRP gel educed healing
ime, pain, and an ibio ic use (p < 0.001). In Snodg ass u e h oplas y (hypospadias), PRP
educed he incidence o u e h ocu aneous is ulas (10% s. 25%). In pedia ic maxillo acial
su ge y (child en aged 8-15 yea s), he combina ion o PRP wi h au ogenous bone g a ing
a e cys enuclea ion showed signi ican ly highe egene a ion (94% de ec illing a e 6
mon hs compa ed o 47% in he con ol g oup; p < 0.05).
Conclusions. PRP is a sa e, biocompa ible adju an in pedia ic su ge y. I imp o es
wound healing and bone egene a ion ou comes and educes complica ions in p ocedu es such
as ea ing hypospadias, pilonidal sinus, and meningomyelocele. The au ologous na u e o
PRP elimina es he isks o immune ejec ion and in ec ion. Adding PRP o bone g a s
signi ican ly enhances bone egene a ion in child en. Fu he esea ch is needed o s anda dize
p epa a ion and dosage p o ocols, as a iabili y a ec s ou comes.
Keywo ds: pla ele - ich plasma; PRP; pedia ic su ge y; issue egene a ion;
bone egene a ion; wound healing; child en
In oduc ion
Pla ele - ich plasma (PRP) is a plasma concen a e en iched wi h pla ele s, g ow h
ac o s, and cy okines ha p omo e issue egene a ion by accele a ing healing, educing
in lamma ion, and enhancing eco e y. This echnology is based on an au ologous sou ce,
which minimizes he isks o immune ejec ion, making i cos -e ec i e and e sa ile in
3
su ge y, especially in pedia ics, whe e healing can be complica ed due o he delicacy o
p ocedu es such as he econs uc ion o congeni al de ec s. The his o y o au ologous PRP
da es back o he mid-20 h cen u y, when in 1954 he e m ‘pla ele - ich plasma’ was i s
used o s anda d pla ele concen a es in ans usion medicine. In he 1970s, PRP began o be
used in econs uc i e su ge y o educe blood loss, and in he 1980s, o he egene a ion o
damaged issues, such as skin ulce s, h ough he elease o g ow h ac o s, including pla ele -
de i ed g ow h ac o (PDGF), epide mal g ow h ac o (EGF), and ascula endo helial
g ow h ac o (VEGF) [1]. In pedia ic su ge y, PRP is pa icula ly aluable o s imula ing
issue egene a ion in cases o congeni al anomalies, auma, and pos -ope a i e healing,
whe e adi ional me hods may no be su icien ly e ec i e. Pla ele s a e ich in g ow h
ac o s and cy okines ha induce wound healing and issue egene a ion mechanisms,
including an os eogenic e ec o imp o e implan a ion in maxillo acial su ge y. PRP is a
na u al sou ce o g ow h ac o s and is success ully used in den is y, plas ic su ge y,
auma ology, and o hopedics o he egene a ion o a ious issues, al hough a s anda dized
p o ocol o p epa a ion and applica ion has no ye been es ablished [2, 3].
The aim o he s udy
This a icle aims o e iew he use o pla ele - ich plasma (PRP) in pedia ic su ge y
o issue egene a ion, emphasizing i s e ec i eness in pedia ic p ocedu es such as wound
healing, bone egene a ion, and educ ion o pos ope a i e complica ions. The e iew is based
on an analysis o clinical s udies and sys ema ic e iews demons a ing he ole o PRP as an
au ologous bios imulan ha enhances cell p oli e a ion, mig a ion, and di e en ia ion in he
healing p ocess, ocusing on pedia ic pa ien s o minimize isks and op imize eco e y. The
s udy aims o e alua e PRP as an adjunc o s anda d me hods, such as bone g a s o su gical
econs uc ions, o es ablish i s po en ial in ou ine clinical p ac ice o child en.
Ma e ials and me hods
This e iew a icle is based on a sys ema ic analysis o scien i ic li e a u e on he use
o pla ele - ich plasma (PRP) in pedia ic su ge y o issue egene a ion. Da a om clinical
s udies, sys ema ic e iews, and p eclinical s udies published in pee - e iewed jou nals we e
used o ensu e objec i i y and eliabili y. The li e a u e sea ch was conduc ed in PubMed,
ELSEVIER, and o he medical a chi es using keywo ds such as: ‘pla ele - ich plasma’,
“PRP”, ‘pedia ic su ge y’, ‘ issue egene a ion’, ‘bone egene a ion’, ‘wound healing’,
‘child en’, and hei combina ions. The inclusion c i e ia co e ed a icles in English published
be ween 2000 and 2024, ocusing on pedia ic pa ien s (aged unde 18), clinical applica ions
4
o PRP o issue egene a ion, and he a ailabili y o quan i a i e o quali a i e da a on
e icacy.
Resul s and discussion
Pla ele - ich plasma (PRP) is an au ologous p oduc ob ained om he pa ien 's blood
by Cen i uga ion, con aining a pla ele concen a ion 3-5 imes highe han he baseline le el
in pe iphe al blood. PRP ac s as a con olled deli e y sys em o bioac i e molecules ha
p omo e issue egene a ion by modula ing in lamma ion, s imula ing cell p oli e a ion,
angiogenesis, and ex acellula ma ix (ECM) syn hesis [4, 5]. I s mechanisms o ac ion a e
based on he elease o pla ele con en s upon ac i a ion, which mimics he physiological
p ocesses o wound healing and issue epai , emphasizing he syne gy o g ow h ac o s,
cy okines, and s uc u al elemen s such as he ib in sca old [6, 20].
PRP is p epa ed om he pa ien 's enous blood ( olume 10-60 ml), an icoagula ed
wi h sodium ci a e (be e han hepa in, as i p ese es pla ele unc ion and educes
mic o esicula sec e ion). In pedia ic su ge y, PRP p epa a ion is adap ed o age
cha ac e is ics: o child en olde han 12 mon hs, au ologous enous blood ( olume 10-20
ml) is used, while o in an s, umbilical co d blood o dono PRP om pa en s is o en used
[7, 21]. Cen i uga ion (1500-3000 pm o 3-15 minu es) sepa a es he blood in o laye s:
e y h ocy es (disca ded o a oid in lamma ion om hemolysis), a bu e laye (leukocy es,
o en excluded in leukocy e-poo PRP o educe p o-in lamma o y e ec s), and pla ele -
en iched plasma (concen a ion 2-3 imes highe han baseline, 150,000-400,000 pla ele s/μl).
The op imal pla ele concen a ion a oids inhibi ion o cell p oli e a ion a excessi e doses
[8]. Ac i a ion ini ia es he elease o pla ele con en s and he o ma ion o a ib in mesh o
con olled deli e y o molecules. Exogenous ac i a ion occu s by physical me hods ( eezing-
hawing) o addi i es, such as calcium chlo ide (p e e ably o a oid hypocalcemia om
an icoagulan s) o h ombin, o ming an injec able solu ion o ib in clo /memb ane o
su gical use. Endogenous ac i a ion occu s na u ally a e adminis a ion. Ac i a ion leads o
pla ele deg anula ion, elease o α-g anule con en s (g ow h ac o s, in lamma o y
media o s), δ-g anules (coagula ion ac o s, asoac i e amines), and lysosomes, ollowed by
polyme iza ion o ib inogen in o a ib in mesh ha aps molecules o g adual elease [9].
PRP con ains plasma biomolecules and pla ele con en s, o ming a syne gis ic
cock ail o housands o molecules ha egula e hemos asis, epai , in lamma ion, and
p o ec ion. Pla ele s (disc-shaped, non-nuclea ed, 2-3 μm in diame e , wi h a li espan o 7-10
days) s o e ma e ials in g anules: α-g anules (g ow h ac o s, in lamma o y media o s), δ-
g anules (coagula ion ac o s, asoac i e amines), and lysosomes. The eleased elemen s
5
include adhesi e p o eins ( ib in, ib onec in, i onec in), ib inolysis/coagula ion ac o s,
an imic obial agen s, cy okines, g ow h ac o s, mic opa icles (an i-in lamma o y), and
exosomes ( o cell communica ion). Plasma adds ci cula ing molecules, and a ia ions
(pla ele coun , p esence o leukocy es, e y h ocy es — a oided o p e en
s ess/in lamma ion) a ec e icacy; leukocy e-poo PRP is op imal o join s. The
concen a ion o g ow h ac o s in PRP is signi ican ly highe : TGF-β — 7 imes, PDGF —
30 imes, EGF — 10 imes compa ed o whole blood, acco ding o ELISA da a [10, 11].
G ow h ac o s eleased om α-g anules upon ac i a ion a e he basis o egene a ion:
• PDGF (pla ele -de i ed g ow h ac o ): Chemo ac ic o cells ( ib oblas s, bone
ma ow s em cells, p eos eoblas s); s imula es mi ogenesis (cell p oli e a ion), angiogenesis
( o ma ion o new blood essels), mac ophage ac i a ion; p omo es ca ilage and meniscus
epai ; ac i a es cell memb ane ecep o s, gene a ing high-ene gy phospha e bonds o
signaling p o eins.
• TGF-β ( ans o ming g ow h ac o -be a): An ip oli e a i e o epi helial cells; ac s
pa ac inally and au oc inally on ib oblas s, s em cells, p eos eoblas s; inhibi s os eoclas
o ma ion, p omo es bone egene a ion and emodeling; in luences ea ly epai , s em cell
di e en ia ion, ca ilage/subchond al bone main enance; s imula es endocy e p oli e a ion,
collagen I/III syn hesis
• VEGF ( ascula endo helial g ow h ac o ): S imula es asculogenesis and
angiogenesis; inc eases ascula densi y, suppo s endon healing; o iginally iden i ied as a
ascula pe meabili y ac o .
• EGF (epide mal g ow h ac o ): Binds o he EGFR ecep o ; s imula es cell g ow h,
p oli e a ion, and di e en ia ion; p omo es cell mig a ion
• IGF-1 (insulin-like g ow h ac o -1) and HGF (hepa ocy e g ow h ac o ): S imula e
endocy e p oli e a ion and collagen syn hesis; an i-in lamma o y, inhibi he NF-κB pa hway,
educe p o-in lamma o y cy okines (IL-1β, TNF-α, IL-6, IL-10, PGE2).
• bFGF (basic ib oblas g ow h ac o ): Key o mig a ion, p oli e a ion,
di e en ia ion, and angiogenesis [4, 5, 7, 12].
PRP a ec s in lamma ion, pain, lub ica ion, and cellula esponse:
Con ol o local in lamma ion is a key mechanism; pla ele s ec ui immune cells
(neu ophils, monocy es, mac ophages) ia chemokines and in e leukins, clea ing deb is and
pa hogens bu p e en ing excessi e eac ion; mac ophage ansi ion om M1 (p o-
in lamma o y) o M2 ( epa a i e) ia mic opa icles and IL-1Ra; inhibi ion o p o-
in lamma o y molecules (IL-1β, TNF-α, PGE2) in chond ocy es, ib oblas s, os eoblas s,
6
mac ophages [4]. Pain educ ion h ough in lamma ion educ ion (PGE2 ia NF-κB
inhibi ion) and s imula ion o he endocannabinoid sys em (anandamide, 2-
a achidonoylglyce ol as CB1/CB2 ecep o agonis s), educing he nocicep i e esponse.
Inc eased g ow h, mig a ion, p oli e a ion o chond ocy es; educed apop osis; enhanced
syn hesis o glycosaminoglycans (GAG), p o eoglycans, collagen; o mesenchymal s em
cells (MSC) — inc eased p oli e a ion, chond ogenic po en ial [13]. Angiogenesis and
epi helializa ion: VEGF, PDGF, FGF, and EGF p omo e neo ascula isa ion and e-
epi helializa ion; in ull- hickness wounds, he e is accele a ed closu e [14].
In pedia ic gene al su ge y, PRP educes pos ope a i e complica ions and accele a es
healing. In a andomized s udy by A abacı Ö., Akyol ME. e al. (2023), 40 in an s wi h
meningomyelocele (mean age 1.5 days) a e p ima y econs uc ion o he sac, PRP gel
applied o he de ec si e signi ican ly educed ce eb ospinal luid leakage (5% s. 45% in he
con ol g oup), meningi is (0% s. 35%), pa ial skin nec osis (15% s. 65%) and wound
dehiscence (15% s. 35%; all p < 0.05), wi h no signi ican di e ences in comple e skin
nec osis (0% s. 5%; p > 0.05). This is associa ed wi h enhanced angiogenesis, ib oblas
p oli e a ion, and collagen syn hesis, which imp o es issue in eg a ion in ulne able in an s
[15].
In he ea men o pilonidal sinus (a disease common in adolescen s) in a andomised
s udy by Di Mi i M., D'An onio S. e al. (2024) 49 pa ien s (mean age 25 yea s, bu wi h
paedia ic implica ions) PRP gel a e excision educed healing ime (p < 0.001), pain on he
VAS scale (p < 0.001), an ibio ic use (p < 0.001) and angiogenesis (p < 0.001), wi h a
co ela ion be ween ca i y olume and eco e y ime (p < 0.001), educ ion in analgesics (p <
0.001) and as e e u n o ac i i y (p ≤ 0.003), demons a ing po en ial o adolescen su ge y
[1, 16].
Fo hypospadias, PRP as a ba ie laye in Snodg ass u e h oplas y (33 pa ien s)
educed he incidence o u e h ocu aneous is ulas (10% s. 25%), s enosis (5% s. 20%) and
in ec ions (p < 0.05) a 1-5 mon hs; in 180 pa ien s, PRP o e u e h oplas y educed o e all
complica ions ( is ulas, in ec ions, dehiscence, s enosis; p < 0.05) [23].
In en e ocu aneous is ulas, PRP gel om umbilical co d blood closed an
oesophagocu aneous is ula in an in an a e oesophagoplas y, wi h comple e healing a e
h ee applica ions, imp o ed sca quali y, and no ecu ence. In musculoskele al su ge y, PRP
is used o ju enile idiopa hic a h i is (in a-a icula injec ions educe in lamma ion) and
ligamen inju ies (accele a es endon epai ), wi h po en ial o congeni al anomalies such as
spina bi ida, whe e PRP as an adju an imp o es neu onal egene a ion [17].
7
PRP is a powe ul os eoinduce en iched wi h g ow h ac o s o enhance bone and so
issue egene a ion in pedia ic maxillo acial su ge y and den is y. In a clinical s udy by
Naga eni NB., P a een RB. e al. (2010), 20 child en (aged 8-15 yea s) a e enuclea ion o a
jaw cys , he combina ion o PRP wi h au ogenous bone g a demons a ed signi ican ly
highe egene a ion: 58% de ec illing a e 1 mon h, 72% a e 2 mon hs, 84% a e 4
mon hs, and 94% a e 6 mon hs, compa ed o 31%, 36%, 41%, and 47% in he con ol g oup
wi hou PRP (p < 0.05 a all in e als), wi hou complica ions, indica ing po en ial o ou ine
use in paedia ic bone de ec s [18, 19, 22].
Conclusions
PRP is a sa e, biocompa ible adju an in pedia ic su ge y ha imp o es ou comes in a
a ie y o applica ions, such as wound healing, bone egene a ion, and educ ion o
complica ions in p ocedu es such as hypospadias epai , pilonidal sinus, and
meningomyelocele. I s au ologous na u e elimina es he isks o immune ejec ion and
in ec ion. Adding PRP o bone g a s signi ican ly enhances bone egene a ion in child en,
wi h po en ial o ou ine clinical use in he egene a ion o bone de ec s a e cys
enuclea ion. The combina ion o PRP wi h s em cells imp o es os eogenesis and ca ilage
egene a ion, al hough esul s a e con o e sial o pe iodon al egene a ion. PRP may
become an in aluable ool o issue egene a ion o pedia ic den is s wo ldwide. Fu he
esea ch is needed o s anda dize p o ocols and dosages and o con i m e icacy in la ge
samples, as a iabili y in p epa a ion a ec s esul s.
Funding.
The s udy was conduc ed wi hou inancial suppo .
Con lic o in e es .
The au ho s decla e ha he s udy was conduc ed wi h no con lic s o in e es ,
inancial, au ho ship, o o he na u e ha could ha e in luenced he cou se and esul s o he
esea ch in his a icle.
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