N 5 (196) 2025. P. 52–55

APPLICATION OF PERINEURAL ADMINISTRATION OF FIBROBLASTS AND PRP IN TOURNIQUET SYNDROME: A SURGEON’S PERSPECTIVE

I. M. Samarskyi, M. A. Kashtalian, V. O. Tsepkolenko, D. M. Davydov

Military Medical Clinical Center of the Southern Region, Odesa, Ukraine
Odesa National Medical University, Odesa, Ukraine
Plastic Surgery Institute “Virtus”, Odesa, Ukraine

DOI 10.32782/2226-2008-2025-5-8

Introduction. Tourniquet syndrome causes compression-ischemic neuropathy and remains a significant challenge in combat-related limb injuries. Regenerative therapies using platelet-rich plasma (PRP) and fibroblasts may enhance neural recovery through trophic, angiogenic, and anti-inflammatory mechanisms.

Objective. To evaluate the clinical efficacy of perineural administration of PRP and autologous dermal fibroblasts in patients with tourniquet-induced neuropathy.

Materials and methods. A prospective study was conducted at the Military Medical Clinical Center of the Southern Region (Odesa, 2023–2024). Thirty-two patients with lower-limb injuries complicated by tourniquet application were examined. Group I (n = 17) received multimodal pharmacotherapy plus perineural PRP injections (3 sessions of 4 mL under ultrasound guidance) followed two weeks later by autologous fibroblast transplantation (30 million cells). Group II (n = 15) received pharmacotherapy only. Outcomes included pain intensity (VAS), motor and sensory function recovery, hospital stay duration, and complications.

Results. Group I demonstrated significantly faster reduction of neuropathic pain (VAS decreased from 8.9 to 3.6 at one month vs. 9.1 to 4.9 in controls, p < 0.05), earlier return of active distal motor function (10–14 days vs. > 4 weeks), and quicker recovery of tactile and pain sensitivity (7–10 days vs. approximately 4 weeks). Length of hospital stay was reduced by 10–17 days (35.8 ± 4.2 vs. 57.3 ± 5.1 days). Analgesic demand decreased by 50% after 2 weeks and by 75% at one month. No infectious complications occurred; local pain and transient edema were the most common mild adverse effects. No amputations were required.

Conclusions. Perineural PRP and fibroblast therapy accelerates functional recovery, decreases analgesic load, and shortens rehabilitation period in tourniquet neuropathy. The approach appears safe and feasible in military hospital practice but requires multicenter randomized trials to standardize dosing, timing, and protocols.

Keywords: military surgery, limb vasculature, tourniquet syndrome, regenerative medicine, rehabilitation.

REFERENCES

  1. Sheean AJ, Anz AW, Bradley JP. Platelet-rich plasma: fundamentals and clinical applications. Arthroscopy. 2021 Sep;37(9):2732-4. doi:10.1016/j.arthro.2021.07.003. PMID:34481615.
  2. Goshchynsky VB, Migenko BO, Svidersky UU. Zastosuvannia PRP ta PRF tekhnolohii u pidhotovtsi do vykonannia radiochastotnoi abliatsii ven u khvorykh na varykoznu khvorobu nyzhnikh kintsivok, uskladnenu trofichnoiu vyrazkoiu [Application of PRP and PRF technologies in the preparation for radiofrequency ablation of veins in patients with varicose disease of the lower extremities complicated by trophic ulcer]. Zdobutky klinichnoi i eksperymentalnoi medytsyny. 2019;(2):99-104. doi:10.11603/1811-2471.2019.v0.i2.10376.
  3. Samarskiy IM, Khoroshun EM, Vorokhta Y. The use of tourniquets in the Russo-Ukrainian war. J Spec Oper Med. 2024 Mar 13. doi:10.55460/CB0O-GYYX. Epub ahead of print. PMID:38408044.
  4. Schwab ME, Strittmatter SM. Nogo limits neural plasticity and recovery from injury. Curr Opin Neurobiol. 2014 Aug;27:53-60. doi:10.1016/j.conb.2014.02.011. PMID:24632308; PMCID:PMC4122629.
  5. Öztürk GT, Erden E, Erden E, Ulašlı AM. Effects of ultrasound-guided platelet rich plasma injection in patients with piriformis syndrome. J Back Musculoskelet Rehabil. 2022;35(3):633-9. doi:10.3233/BMR-210032. PMID:34397402.
  6. Yang Z, Hou N, Cheng W, et al. MiR-378 exaggerates angiogenesis and bone erosion in collagen-induced arthritis mice by regulating endoplasmic reticulum stress. Cell Death Dis. 2024 Dec 18;15(12):910. doi:10.1038/s41419-024-07193-5. PMID:39695085; PMCID:PMC11655635.
  7. Zavala A, Martinez PC, Gutierrez GG, Vara MD, Pawlikowski W. The combined use of curcumin and platelet-rich plasma enhances axonal regeneration in acute nerve injuries: an experimental study in a rat model. J Hand Microsurg. 2020 Nov 23;15(1):31-6. doi:10.1055/s-0040-1721562. PMID:36761053; PMCID:PMC9904982.
  8. Odložilová Š, Paral J, Sirovy M, Zajak J, Fibír A. Platelet-rich plasma: characteristics and current review of its use in surgery. Pol Przegl Chir. 2024 Jul 9;96(5):66-74. doi:10.5604/01.3001.0054.6750. PMID:39465631.
  9. Means GE, Muench P. Platelet-rich plasma injections for the treatment of degenerative orthopedic conditions. Mil Med. 2024 Jul 3;189(7-8):207-8. doi:10.1093/milmed/usae025. PMID:38349194.
  10. Xu PC, Xuan M, Cheng B. Effects and mechanism of platelet-rich plasma on military drill injury: a review. Mil Med Res. 2020;7:56. doi:10.1186/s40779-020-00285-1.
  11. Badyin I, Khramtsov D, Vorokhta Y. The use of platelet-rich plasma in the treatment of patients with chronic dorsalgia. Int Neurol J. 2024;20(5):217-20. doi:10.22141/2224-0713.20.5.2024.1088.
  12. Castle CD, Dunderdale CM, Patzkowski JC, Carius BM. Platelet-rich plasma improves strength and speed of recovery in an active-duty soldier with isolated injury to the lateral collateral ligament of the knee: a case report. Med J (Ft Sam Houst Tex). 2023 Apr-Jun;(Per 23-4/5/6):17-9. PMID:37042501.
  13. Wang SL, Liu XL, Kang ZC, Wang YS. Platelet-rich plasma promotes peripheral nerve regeneration after sciatic nerve injury. Neural Regen Res. 2023 Feb;18(2):375-81. doi:10.4103/1673-5374.346461. PMID:35900433; PMCID:PMC9396478.
  14. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic-ultrasound correlations. 4th ed. Philadelphia: Elsevier; 2020. ISBN:9780323661805.
  15. Tereshkevych H. T. Osnovy bioetyky i biobezpeky [Fundamentals of Bioethics and Biosafety]. Lviv: Vyd-vo Lviv. un-tu, 2018. 400 p.
  16. Fetisov V. S. Paket statystychnoho analizu danykh STATISTICA [Package of Statistical Data Analysis STATISTICA]. Nizhyn, 2018. 114 p.
View article PDF