Adjuvant Platelet-Rich Fibrin (PRF) Therapy for Wound-Bed Conditioning and Facial Flap Reconstruction: A Systematic Review of Tissue Perfusion and Post-oncological Scar Remodeling.

Facial oncologic surgery can create defects requiring local, regional, or free-flap reconstruction. Platelet-rich fibrin (PRF) is an autologous fibrin matrix containing platelets and leukocytes that has been investigated as a wound-bed conditioning adjunct; however, its role in post-oncological facial flap reconstruction remains uncertain. The objective of this study is to map literature published from 2022 through 2026 on PRF-assisted wound-bed conditioning relevant to tissue perfusion, flap or graft viability, wound healing, and scar remodeling in facial and head-and-neck reconstruction. A structured evidence map informed by PRISMA 2020 reporting principles used PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and supplementary reference-list searching. Human clinical, preclinical, and in vitro evidence was grouped separately to avoid conflating evidential weight. Seventeen core reports were included: 16 human clinical reports and one preclinical flap study. A prospective randomized study of radial forearm flap donor-site reconstruction reported higher skin-graft survival with PRF placed between the wound bed and graft. A case report described delayed deep wound healing after tracheotomy or lymph-node dissection. Adjacent oral and maxillofacial randomized trials reported improvements in selected morbidity or early-healing outcomes, while facial skin studies reported changes in dermal density or scar-related outcomes. To our knowledge, no study directly evaluated objective perfusion, viability, or scar outcomes in post-oncological facial flaps. PRF is biologically plausible as a wound-bed adjunct, but evidence is insufficient to support routine use in post-oncological facial flap reconstruction. Future multicenter studies should use standardized PRF protocols and objective perfusion and scar measures, including laser Doppler methods, indocyanine green angiography, and validated scar scales.