Effectiveness of Platelet-Rich Plasma Combined with Split-Thickness Skin Grafts for Skin Defects: A Systematic Review and Meta-Analysis.

Background/Objectives: Platelet-rich plasma (PRP) has been proposed as an adjunct to split-thickness skin grafting (STSG) to enhance graft adherence and reduce complications. However, evidence remains heterogeneous. This study evaluated the effectiveness of PRP combined with STSG compared with STSG alone. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases and trial registries were searched for randomized controlled trials and comparative observational studies. Ten studies were included. The primary outcome was skin graft take. Secondary outcomes were wound healing time, graft loss, and hematoma incidence. Random-effects models were used. Risk of bias was assessed with RoB 2 and ROBINS-I, and certainty of evidence with GRADE. Results: Ten studies (7 randomized controlled trials and 3 observational studies) were included. PRP improved graft take (mean difference 9.93%; 95% CI: 4.70-15.17; p = 0.0002; I2 = 75%), with a larger effect in patient-level analyses (14.78; 95% CI: 10.97-18.59; p < 0.00001; I2 = 0%). Healing time could not be pooled. Hematoma incidence was reduced (risk ratio 0.26; 95% CI: 0.14-0.48; p < 0.0001; I2 = 0%). Graft loss was reduced in parallel-group trials (risk ratio 0.26; 95% CI: 0.11-0.58; p = 0.001; I2 = 0%) but not in sensitivity analysis (risk ratio 0.35; 95% CI: 0.10-1.19; p = 0.09; I2 = 73%). Evidence certainty was low to very low. Conclusions: PRP may improve graft take and reduce hematoma after STSG, but effects on graft loss and healing time remain uncertain.