Platelet-rich plasma in the surgical management of chronic diabetic foot wounds

Chronic diabetic foot ulcers and postoperative wounds heal poorly because local biological dysfunction interacts with inadequate perfusion, infection and mechanical stress. This narrative review evaluates the biological rationale and clinical evidence for platelet-rich plasma (PRP) as an adjunct to surgical management. Targeted searches and source verification covered PubMed, journal publications and International Working Group on the Diabetic Foot resources. The synthesis relates impaired inflammatory resolution, neutrophil extracellular traps, macrophage inflammasome activity, endothelial dysfunction, fibroblast senescence and matrix turnover to PRP composition and delivery. Platelet dose, leukocyte content, activation and fibrin structure distinguish clinically different products. Some trials report improved complete healing, but small samples, heterogeneous comparators and formulation-specific effects limit generalisation. Evidence for an autologous leukocyte/platelet/fibrin patch is more persuasive than evidence for conventional PRP, whose routine use is not supported by current guideline recommendations. Engineered carriers and isolated exosomes remain distinct experimental interventions. Any platelet-based adjunct requires assessment of perfusion, revascularisation when indicated, infection control, debridement and pressure relief. No universal concentration or application schedule has been established. Wound-bed readiness, graft take, sustained epithelial closure and recurrence represent separate outcomes. The biological rationale remains promising, but surgical integration requires cautious product-specific interpretation and better clinical trials that connect reproducible preparation methods with durable healing and function.