Autologous platelet-rich gel for refractory plantar ulcer following ethanol sclerotherapy of peripheral venous malformation - a Case Report

Sep 28, 2026

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Autologous platelet-rich gel (APG), a gelled form of autologous platelet-rich plasma, delivers growth factors in a fibrin scaffold to promote angiogenesis, granulation, and re-epithelialization. The case describes a 25-year-old woman who developed a refractory plantar ulcer with tendon exposure after combined absolute-ethanol sclerotherapy and surgical excision for a congenital peripheral venous malformation of the left foot. Microcirculatory compromise from sclerosant reflux led to full-thickness skin necrosis. After three APG applications, the ulcer area decreased by 95% and complete epithelialization occurred within one month without scar contracture, yielding excellent functional and cosmetic outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Peripheral venous malformations and ulcer risk

Platelet-rich plasma and APG mechanism

Evidence for PRP in chronic wounds

TYPE Case Report PUBLISHED 18 December 2025 DOI 10.3389/fbioe.2025.1700377 OPEN ACCESS EDITED BY Mona Kamal Marei, Alexandria University, Egypt REVIEWED BY Jose Luis Ramirez-GarciaLuna, Universidad Autónoma de San Luis Potosí, Mexico Alexander Leonardo Silva Junior, Universidade Estadual de Campinas, Brazil Yanquan Liu, Nanchang University, China Rajkapoor Balasubramanian, Karpagam Academy of Higher Education, India Yasodha Krishna Janapati, United States International University-Africa, Kenya *CORRESPONDENCE Jie Tang, [tjandbetty@sc-mch.cn](tjandbetty@sc-mch.cn) †These authors have contributed equally to this work RECEIVED 13 September 2025 REVISED 18 November 2025 ACCEPTED 26 November 2025 PUBLISHED 18 December 2025 CITATION Zhao Z, Wu S, He X, Zhang Y, Chen X and Tang J (2025) Autologous platelet-rich gel for refractory plantar ulcer following ethanol sclerotherapy of peripheral venous malformation: a Case Report. Front. Bioeng. Biotechnol. 13:1700377 . doi: 10.3389/fbioe.2025.1700377 COPYRIGHT © 2025 Zhao, Wu, He, Zhang, Chen and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Autologous platelet-rich gel for refractory plantar ulcer following ethanol sclerotherapy of peripheral venous malformation: a Case Report Zhenyu Zhao 1†, Shaohui Wu 2†, Xiaoyan He 1†, Yan Zhang 2, Xuemei Chen 1 and Jie Tang 3* 1Transfusion Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China, 2Department of Vascular Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China, 3Transfusion Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China/NHC Key Laboratory of Nuclear Technology Medical Transformation (Mianyang Central Hospital), Mianyang, China Platelet-rich plasma (PRP) contains a high concentration of growth factors that promote angiogenesis, granulation-tissue formation and re-epithelialization, thereby signiﬁcantly accelerating wound healing. Autologous platelet-rich gel (APG), a gelled form of PRP, provides a sustained release of these factors within a ﬁbrin scaffold. We report a 25-year-old woman who developed a refractory plantar ulcer with tendon exposure after combined absolute-ethanol sclerotherapy and surgical excision of a congenital venous malformation of the left foot. Reﬂux of the sclerosant produced microcirculatory compromise, followed by full-thickness skin necrosis. Because the plantar skin is under high tension and has a relatively poor blood supply, conventional skin grafting was deemed unlikely to succeed. APG was therefore employed as a salvage treatment. After three applications, the ulcer area had decreased by 95%, and complete epithelialization was achieved within 1 month without scar contracture. Both functional and cosmetic outcomes were excellent. This case illustrates that APG promotes granulation and re-epithelialization of intractable ulcers following sclerotherapy for venous malformations, which reducing the need for grafting and representing a valuable adjunct for wounds with tendon exposure and compromised perfusion. KEYWORDS autologous platelet-rich gel, venous malformation, refractory ulcer, growth factors, case report Introduction Peripheral venous malformations (PVMs) are congenital low-ﬂow vascular anomalies characterized by dilated venous sinusoids and aberrant venous channels (Van Damme et al., 2020) . Sclerotherapy with agents

FAQs

Why did the plantar ulcer become refractory after ethanol sclerotherapy?

Reflux of the sclerosant caused microcirculatory compromise, which progressed to full-thickness skin necrosis. High plantar skin tension and poor vascularity reduced the likelihood of conventional skin graft success.

How does autologous platelet-rich gel (APG) support wound healing?

APG provides sustained release of growth factors within a fibrin scaffold. This promotes granulation tissue formation and re-epithelialization while supporting hemostasis, space occupancy, and cell adhesion.

What were the clinical outcomes after APG treatment in this case report?

After three APG applications, the ulcer area decreased by 95%. Complete epithelialization was achieved within one month without scar contracture, with excellent functional and cosmetic results.

Sep 28, 2026

Uploaded by Bintang