Please cite this article in press as: Agarwal B, et al. Optimum use of platelet-rich fibrin: technical note. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.04.016 ARTICLE IN PRESS YBJOM-4506; No. of Pages 2 British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx Available online at www.sciencedirect.com Technical note Optimum use of platelet-rich fibrin: technical note B. Agarwal, S. Gagnani, A. Roychoudhury, O. Bhutia * Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India Accepted 19 April 2015 Keywords: Platelet-rich plasma; Fibrin mesh; Growth factor The role of platelet-rich fibrin is well-established in oral and maxillofacial surgery. 1,2 It is theoretically a fibrin mesh in which platelets are trapped. 3 Platelets have -granules within them, which contain many valuable growth factors such as platelet-derived growth factor, transforming growth factor- , vascular endothelial growth factor, and epidermal growth factor, all of which optimise the healing process. 4 The currently-used technique, in which the clot is squeezed to the thickness of a membrane between 2 pieces of dry, sterile gauze, 5 may result in loss of these vital growth factors. The maximum release occurs within the first hour of making the platelet-rich fibrin. 4 We propose a new method of conserving them, which involves the use of sterile, long, non-toothed, tissue-holding forceps, a 50 ml syringe with an eccentric nozzle on the side (Romo-Jet TM 50 ml, Romsons, Agra, India), a 5 ml syringe, and a three-way stopcock (Bi-Valve ® Romsons, Agra, India). The clot is obtained by centrifuging 10 ml of venous blood without anticoagulant at 1300 rpm for 14 minutes using a standard device (A-PRF ® 12, Nice, France). When the clot is ready, it is retrieved from the tube with non-toothed forceps, and the lower red thrombus cut off with scissors. With care taken that it is not dropped, it is then placed carefully at the bottom of a 50 ml syringe. The plunger of the syringe is then replaced. A syringe with an eccentric nozzle is chosen so that the clot does not get trapped. The 50 ml syringe is inserted * Corresponding author at: Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Tel.: +91 9313349564. E-mail address: dr ongkila@rediffmail.com (O. Bhutia). into one of the 3 ports of the 3-way stopcock, a 5 ml syringe (for collection of the squeezed fluid) into another, and the third port is kept as an overflow device for air (Fig. 1). The air is expelled from the 50 ml syringe by pushing the plunger close to the clot. The direction of the valve of the stopcock is then changed to close the third port (the overflow) so that when it is squeezed, the fluid goes only into the 5 ml syringe. The plunger is pushed gently against the clot, squeezing it until it is a thin membrane (Fig. 2). The fluid collected in the 5 ml syringe can then be used as needed (Fig. 3). The plunger is withdrawn from the 50 ml syringe with the flat membrane of platelet-rich fibrin sticking to it. The membrane is then removed with sterile non-toothed forceps and is ready for use (Fig. 4). Fig. 1. Platelet-rich fibrin clot in the 50 ml syringe ready for squeezing (note the position of the valve of the stopcock,and the third port is open). http://dx.doi.org/10.1016/j.bjoms.2015.04.016 0266-4356/© 2015 Published by Elsevier Ltd. on behalf of The British Association of Oral and Maxillofacial Surgeons.