Initial Experience Using an Autologous Blood Clot to Promote Closure in Chronic Pressure Ulcerations

Abstract Body: Wounds that do not heal with standard of care within an acceptable amount of time are referred to as hard-to-heal wounds. Over the past several years, there has been an outpouring of novel products for the treatment of such wounds. Pressure ulcerations are one example of hard-to heal wounds. Pressure ulcers are chronic wounds in which the microenvironment is marginally ischemic due to microvascular compromise and nutrient depletion. Improved healing outcomes have been shown for chronic pressure ulcerations by re-creating a wound microenvironment in which the acute phase of wound healing has been restarted by directing acute phase reactants to the wound. One such product showing potential promise for wound healing is an autologous blood clot formulated to serve as a topical dressing applied weekly. The proposed mechanism of action postulated is that wound healing is stimulated by cell to cell signaling within the local wound milieu. This includes release of growth factors, particularly VEGF, TGF, &PDGF, from the macrophages and secondary platelet plug complex within the  whole-blood autograft. These factors mobilize monocyte migration to the wound, stimulate differentiation into macrophage subtypes, and promote angiogenesis. In effect, the whole blood autograft is though to recreate the acute phase of wound healing. To date (Fall 2019), 3 clinical trials have been performed using the whole-blood autograft. A total of 39 study subjects showed and average of 64% wound area reduction at 4 weeks and 71.5% rate of wound closure. In addition, several case studies have presented complete wound closure with application of the whole blood autograft (Donner et al 2018). We present a case series elucidating the progress in wound are reduction and closure In patients suffering from pressure ulcerations. All wounds were in a state of persistent non-healing despite conventional standard of care treatments for greater than 90 days. The patients were referred for the autograft treatments all performed in one facility. The patients demonstrated a reduction in wound surface area if not outright closure. This Case series provides further evidence of the product's efficacy. The whole blood autograft is a cost conscious and effective product that warrants further study.