Cicatrization of Oncological Wounds by Autologous Fibrin Biopolymer Dressing Treatment: A Case Series

Chronic wounds are characterized by a persistent inflammatory phase, prolonged infection, and failure of the immune system cells to respond to environmental stimuli. These lesions represent a substantial challenge for conventional dressings since the wounds remain open for months or even years,^1,2 negatively affecting a patient’s quality of life and leading to considerably high medical costs.³

Traditional therapies are often expensive, time-consuming, and have limited effectiveness⁴ since they cannot provide the growth factors essential for healing.^5-7 Generally, these conventional wound dressings repair the wound by forming connective tissues, but they do not restore the tissue’s functional integrity.⁸

One natural biomaterial candidate for treating acute or chronic wounds is the FM formed from fibrin-rich plasma. This autologous 3D biopolymer is easily prepared and is full of cytokines and growth factors paramount to wound healing.⁹

In the current work, the authors studied the use of autologous FM as a dressing in treating chronic oncological wounds, evaluating the reduction of the wound area, healing, and adverse effects.

The study, which was approved by the Human Research Ethics Committee (Protocol # 51787321.9.0000.0098), included 3 patients from the Erasto Gaertner Hospital in Curitiba, Brazil, who presented with oncological wounds that had been treated with conventional therapy for more than 6 months with no sign of healing. All the lesions were from surgical resection of tumors: Patient A had neurofibromatosis with melanoma in the cervical region, Patient B had fibrosarcoma at the base of the skull, and Patient C had breast carcinoma.

The patients went through a peripheral venous puncture in the upper limb with a vacutainer-needle system coupled to the closed system tube free of anticoagulants, and 30 mL to 80 mL of blood was extracted from each patient using 10 mL tubes. The tubes were centrifugated (Centrifuge 80-2b 12 tube; Centribio) at 770 g for 12 minutes at 20°C. After centrifugation, the fibrin-rich plasma clot was isolated with a sterile clamp and scissor, discarding the red cells that adhered to its end. The exudate (growth factor rich) was reserved to irrigate the wound.

The FM was applied weekly on the wound bed according to the following protocol: cleaning the wound with 0.9% saline solution; drying the surface area; irrigating with exudate (which remained from the blood centrifugation); applying the FM; applying nonadherent gauze; and covering with a secondary coverage (sterile gauze and bandages). Patients were instructed to change only the secondary coverage daily.

The wounds were documented with a digital camera, measured, and evaluated in their appearance and odor every week until healed. The oncological wounds were staged as follows: stage 1 was intact skin, reddish or violet-colored tissue; stage 2 was an open wound reaching the dermis and epidermis with superficial ulcerations, no or small amounts of exudate, occasional pain, and odor; stage 3 was a wound contemplating the subcutaneous tissue with necrosis and presence of exudate and odor; and stage 4 was a tumor wound with the invasion of deep tissues and presence of exudate in considerable quantity, odor, and pain.¹⁰ The 3 wounds studied were initially classified as stage 2. The wounds’ appearance before the FM intervention can be seen in Figure 1.

On the first day, the patients reported pain and a bad smell. The authors noted the presence of biofilm, exudate (as seen in Figure 1), and a bad odor. Figure 2 presents the images of the wounds as treatment progressed.

In Figure 2, one can see that wounds from Patients A and C were wholly healed after 6 and 5 applications of FM, respectively. In Patient B, the healing process was slower (7 weeks), presenting a 44% area reduction. The measurements taken each week (Table) demonstrate the fast-healing process of the lesions week by week and are confirmed by the images from Figure 2. As of the time of writing, Patient B continues with the treatment.

The 3 patients also reported pain relief after the second week of treatment with the FM, and the odor initially classified as grade I for the 3 wounds decreased to grade 0 after the second week. Reports of discomfort felt by patients were also recorded weekly by the principal researcher nurse. None of the cases presented phlogistic signs and/or symptoms indicative of wound infection or adverse reactions.

Autologous FM, either alone or with other materials, has been used as a biological scaffold for stem cells or primary cells to regenerate various tissues¹¹ because of its ability to induce angiogenesis and to release growth factors, leukocytes, and cytokines.^12-14

Although Patients A and C had comorbidities and were older than Patient B, their wounds were healed fully. Even for Patient A, a former smoker, the wound was completely healed in 6 weeks. With no comorbidities, Patient B had the wound area reduced with no complete healing in 7 weeks, which may be explained by the large size of the wound and its location, where frequent movement can slow up the wound healing.

In each patient, the volume of exudate decreased week by week, which was evidence of the healing process. Together with cytokines and platelet cells, the exudate components contain growth factors responsible for tissue regeneration.¹⁵

The results suggest the great benefits of autologous FM for the healing of chronic oncological wounds. However, the weakness of this study is the limited number of cases studied. The next step is to apply this protocol to a larger population of participants in randomized clinical trials. Additional research is needed to gather evidence of the effectiveness of the technology as a viable therapeutic alternative for the treatment of chronic oncological wounds.

The autologous FM dressing demonstrated efficacy in healing recalcitrant oncologic wounds with no adverse effects nor the formation of hypertrophic scars. In Patient B, even without complete healing, the lesion showed scar tissue and edge closure. It is worth noting that before the FM treatment, all 3 wounds had remained open for more than 6 months even though the patients had been treated weekly with conventional therapy. Therefore, it is possible to say that, compared with conventional dressings, the FM is a lower-cost alternative that is easy to prepare and apply. These features justify the effort for continuing its clinical evaluation in chronic wounds, especially in immunosuppressed patients.