**Conflicts of interest**

*3.4.2. Meniscal sutures*

52 Plasma Medicine - Concepts and Clinical Applications

**3.5. PRP in the management of neuropathies**

of SC aimed to repair [58–60].

its use in the theatre room.

tion of the components.

The meniscal sutures are a suitable technique to preserve the structure of the knee and consequently reach greater stability and protection of cartilage. The infiltration protocol is similar to that described in the meniscectomies, but in this case, PRP infiltration is applied not only into the meniscal wall but also into the suture region. An intraarticular infiltration of PRP is carried out when the whole process is finished. After 14 days other intraarticular injections of PRP could be conducted to improve the repair process, depending on the evolution of patient.

PRP products hold an important therapeutic potential as a neuroprotective, neurogenic and neuroinflammatory therapeutic modulator system [46–50] and as enhancer of sensory and motor functional nerve-muscle unit recovery [51–53]. They are applied either as a filler of nerve conduits or vein-muscle grafts across nerve gaps post-trauma by ultrasound-guided perineural and intraneural infiltrations or as scaffolds to bridge or wrap the injured nerve stumps [54–56]. Moreover, there are non-traumatic peripheral injuries such as compression, adhesion and fibrosis [46], where this novel approach may diminish undesirable consequences such as fibrotic scars and denervated organ atrophy, since this adjuvant therapy can speed up the functional recovery of the nerve-muscle unit [55–58]. The therapeutic potential of PRP for nerve repair lies in the prolonged and gradual delivery system of biomolecules and in its function as a transient guidance scaffold for axonal sprouting [51, 57]. Considering Schwann cells (SC) as key in the nerve repair process, they are an idoneal target for the synergic action of neurotrophic and neurotropic factors of PRP. Thus, the release of biomolecules from the fibrin matrix at the beginning of regeneration process would induce several biological effects

In surgical repair by PRP as in the case of end-to-end neurorrhaphy, nerve compression and nerve entrapment, we recommend combining intraneural and perineural infiltrations of liquid PRP with the application of a PRP membrane as scaffold, which wraps the injured tissue.

Good treatment commences with a correct overall diagnosis that entails the highest number

**1.** It should be remembered that inactivated PRP can be stored for 3–4 hours without losing its efficacy. However, once activated, it must be used immediately, in the ensuing 2–3 minutes after activation. This aspect provides us with room for manoeuvre when scheduling

**2.** The volume of the infiltration syringe and the diameter of the needle used will affect the diffusion of PRP within the tissues. The use of small syringes means that large pressures are exerted on the ECM structures during infiltration, thereby accounting for local disrup-

**4. Guidelines for the appropriate use of PRP infiltrations**

of factors implicated in the disease and considers all the best options.

SP is a researcher of BTI (Biotechnology Institute), a dental implant company that investigates in the fields of oral implantology of PRGF-Endoret technology.
