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Accelerated Healing with the Autologous Combined Leukocyte, Platelet, and Fibrin Patch as Adjunct Therapy in Advanced Wound Care: A Case Series

Bryn Morris, Nellie Movtchan, MD – Resident Physician, Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona; Brenda Paul, RN – Nurse, Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona; Alicia Carlson, PA-C – Physician Assistant, Department of Orthopedic Surgery, Mayo Clinic Arizona; Martin Johnson, MD – Attending Physician, Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona; Todd Kile, MD – Attending Physician, Department of Orthopedic Surgery, Mayo Clinic Arizona; Erwin Kruger, MD – Attending Physician, Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona

Presented at Symposium on Advanced Wound Care Spring 2021

OBJECTIVE: The purpose of this study was to evaluate the efficacy of the combined leukocyte, platelet, and fibrin patch* as an adjunct therapy in the management of difficult wounds.

METHODS: Three patients with difficult wounds (Patient 1= 69M, chronic plantar foot neuropathic ulcer of 36 months; Patient 2= 70F with chronic left venous stasis ulcer of 2 months, Patient 3= 48M with post-traumatic calf wound complicated by dehiscence of 4 months) were evaluated in this case series. Wounds were initially managed with conventional wound care. When healing stalled to < 30% wound contraction by area (cm2) for at least 30 days, a fibrin patch* was applied to stimulate the wound. Efficacy was determined by percent of wound contraction from initial treatment to last treatment. Treatment plan was altered based on clinical judgement with the goal of obtaining stable wound closure.

RESULTS: Patients 1, 2 and 3 achieved 98.6% wound contraction in 60 days (10 treatments), 95.6% in 27 days (4 treatments), and 94.7% in 35 days (7 treatments), respectively. All wounds showed rapid decline in wound volume after application of the fibrin patch*. Patient 1 required a secondary procedure (off-loading metatarsectomy with total contact casting) to achieve stable wound closure. Patients 2 and 3 reported significant improvement in pain and achieved epithelialization of their wounds. Management was reverted to local wound care after treatment with the fibrin patch*. Based on ongoing follow-up visits, near complete wound closure has been achieved for each patient.

CONCLUSIONS: We found the fibrin patch* was effective at accelerating wound contraction in an array of complex wounds. With the goal of stable wound closure, regenerative treatments should be evaluated as an adjunct strategy in advanced wound care, which may or may not be employed as a sole remedy. Success in achieving stable, healed wounds should be individualized to the patient and remains influenced by clinical judgement in using available therapies.