APPLICATION OF PERINEURAL ADMINISTRATION OF FIBROBLASTS AND PRP IN TOURNIQUET SYNDROME: A SURGEON’S PERSPECTIVE

Introduction. Tourniquet syndrome causes compression-ischemic neuropathy and remains a significant challenge in combat-related limb injuries. Regenerative therapies using platelet-rich plasma (PRP) and fibroblasts may enhance neural recovery through trophic, angiogenic, and anti-inflammatory mechanisms. Objective. To evaluate the clinical efficacy of perineural administration of PRP and autologous dermal fibroblasts in patients with tourniquet-induced neuropathy. Materials and methods. A prospective study was conducted at the Military Medical Clinical Center of the Southern Region (Odesa, 2023–2024). Thirty-two patients with lower-limb injuries complicated by tourniquet application were examined. Group I (n = 17) received multimodal pharmacotherapy plus perineural PRP injections (3 sessions of 4 mL under ultrasound guidance) followed two weeks later by autologous fibroblast transplantation (30 million cells). Group II (n = 15) received pharmacotherapy only. Outcomes included pain intensity (VAS), motor and sensory function recovery, hospital stay duration, and complications. Results. Group I demonstrated significantly faster reduction of neuropathic pain (VAS decreased from 8.9 to 3.6 at one month vs. 9.1 to 4.9 in controls, p < 0.05), earlier return of active distal motor function (10–14 days vs. > 4 weeks), and quicker recovery of tactile and pain sensitivity (7–10 days vs. approximately 4 weeks). Length of hospital stay was reduced by 10–17 days (35.8 ± 4.2 vs. 57.3 ± 5.1 days). Analgesic demand decreased by 50% after 2 weeks and by 75% at one month. No infectious complications occurred; local pain and transient edema were the most common mild adverse effects. No amputations were required. Conclusions. Perineural PRP and fibroblast therapy accelerates functional recovery, decreases analgesic load, and shortens rehabilitation period in tourniquet neuropathy. The approach appears safe and feasible in military hospital practice but requires multicenter randomized trials to standardize dosing, timing, and protocols.