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García Botero et al. Plast Aesthet Res 2018;5:15 I http://dx.doi.org/10.20517/2347-9264.2018.09 Page 7 of 8

two applications per patient. The incidence of effective granulation ≥ 75% of the ulcer size was observed in
[9]
76.5% of the patients at 5 weeks of treatment initiation . Also, we found a report case of seven patients with
chronic venous ulcers treated with cultured keratinocytes which were transplanted in a fibrin matrix. Results
showed complete ulcer healing in four of seven ulcers treated, with a mean healing time of 14.5 weeks .
[15]
However, it was not possible to conclude that completed ulcer healing was a consequence of the presence
of fibrin matrix or cultured keratinocytes. The authors suggest, based on in vitro and in vivo studies, that
the fibrin residue in cultured keratinocytes may inhibit complete wound healing after the transplantation.
Therefore, the use of low density fibrin, instead of high density, to enhance grafting, keratinocytes survival
and epithelialization was recommended.

Study limitations
The major limitation of the present study is the few studies available evaluating the management of venous
ulcer with fibrin matrix and with or without growth factors. Most studies evaluated ulcers from different
etiologies and ulcer management was done with a combination of fibrin matrix with different products
or non-fibrin matrices. Therefore, it was not possible to perform a meaningful analysis of this type of
intervention.

Conclusions
This review has not identified conclusive evidence for the use of fibrin matrices with or without growth
factors in patients with venous leg ulcers. We found only a few studies that evaluated the results of this
intervention.

DECLARATIONS
Authors’ contributions
Study conception and design, critical revision: García Botero A
Acquisition of data, critical revision: Cantini Ardila JE
Analysis and Interpretation of data, critical revision: Devoz Borja LD
Drafting of manuscript, critical revision: Gómez-Ortega V

Data source and availability
Article searches were performed in MEDLINE, EMBASE, COCHRANE, LILACS and ongoing clinical trials
at ClinicalTrial.gov.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Not applicable.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.