Autologous blood patch treatment of patients with hard-to-heal wounds: a prospective cohort study.

Objective: To describe the effect of autologous blood patch (3CP, Reapplix, Denmark) treatments as a supplement to standard care among patients with hard-to-heal wounds in an outpatient multidisciplinary wound centre (MWC).

Method: The 3CP is an autologous leukocyte- and platelet-rich fibrin patch, which is applied directly into the wound bed. Patients with a wound duration >6 weeks and an unsatisfactory outcome following standard care were considered. Weekly administration of the autologous blood patch was carried out and the wound size was measured using a picture-based area calculation program at three timepoints (first contact with the MWC, initiation of the autologous blood patch treatment and at the end of the autologous blood patch treatment). The effect was followed for one year or until healing.

Results: From June 2016 to September 2019, 36 patients were included. The median age was 63.5 years (interquartile range (IQR): 58-70), and 14 patients were female (38.9%) and 22 were male (61.1%). Median wound duration pre-autologous blood patch was 21.5 weeks (IQR: 11.1-50.0) and median treatment time was 3.4 weeks (IQR: 1.6-5.3). Half of the patients (50%, 18/36) healed in <20 weeks, 30.6% (11/36) healed in 20-52 weeks and 19.4% (7/36) did not heal within a year. There was a significant difference between the mean wound area (±standard deviation) at the start of autologous blood patch treatment and the area at the end: 2.85±3.71cm versus 1.65±2.37cm, respectively (p=0.0017). Treatment was stopped prematurely for 5/36 patients (reasons included wound infection, major amputation, procedure discomfort or withdrawal without reason).

Conclusion: Among MWC patients with hard-to-heal wounds not responding to standard care, autologous blood patch treatment as a supplement to standard wound care expedited wound healing.