Topical Autologous Blood Clot Therapy: An Introduction and Development of Consensus Panel to Guide Use in the Treatment of Complex Wound Types

Abstract

Complex or hard-to-heal wounds can be acute or chronic; the complexity is based on patient-specific local, systemic, and psychosocial factors. Use of autologous tissue can be a significant adjunct to wound closure. Grafts and flaps are the most common autologous tissue used in wound reconstruction. However, patient factors, wound size, and exposed structures may preclude using these methods as primary or even secondary closure techniques. Alternative autologous tissue therapies include those derived from adipose, epidermis or dermis, bone marrow, and blood. Limitations of these treatment modalities include access-related difficulty, cost, creation of a secondary donor site, use of singular or limited cell types, and sparse or contradictory evidence basis of their efficacy of use. A panel of providers experienced in wound care and surgical wound management was convened to create a series of publications on the use of topical autologous blood clot therapy (TABCT) in the treatment of complex wounds. This publication, the first in a series, provides an evidence basis of the gap between definition and treatment of complex wounds, an overview of the use of autologous therapies in these wounds, and the science behind TABCT. The development of a consensus panel for decision pathways and recommendations for TABCT use in specific complex wound types are also discussed. Subsequent articles will provide consensus recommendations on the use of TABCT in full-thickness wounds with exposed tendon and/or bone and undermining or tunneling wounds, in wounds in patients who are nonsurgical candidates, in those who cannot undergo sharp debridement, in patients with arterial wounds who have been maximally revascularized, and in those with transsphincteric anal fistula. This article provides a foundation of knowledge and describes the plan for consensus panel decision pathways and recommendation development of use of TABCT in the treatment of specific complex wound types.

Lower leg ulcer diagnosis and principles of treatment

“…There are few published checklists regarding the assessment of patients with lower leg ulcers. Most of them focus on specific items (140,142,143) and three papers describe a more thorough view (144)(145)(146). The most recent article was written by a panel of authors who highlighted that a checklist is not an algorithm nor a guideline, but a simple tool and a guide to be useful for the majority of…”

Utilization of a topical autologous blood clot for treatment of pressure ulcers

“…The ability of the wound to progress into the proliferative phase depends on this transition, which is dysfunctional in chronic wounds contributing to delayed healing 6 . These effects emphasise the major advantage of TABCT in progression of stagnant wounds from the inflammatory phase to the proliferative phase of wound healing 17 . TABCT also alters the secretion of extracellular proteases in the wound, preventing further distraction of the ECM 22,23 .…”

“…Point-of-care TABCT promotes wound closure by providing a temporary ECM scaffold, delivering and recruiting components necessary for healing to occur, assisting in autolytic debridement, protecting the wound from pathogen entry, and providing a moist wound environment. 17 TABCT has been proposed to contain and attract many growth factors, that is, platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), and transforming growth factor (TGF), necessary for the progression of the wound F I G U R E 2 At day 1 two pressure ulcers noted to the ischium, right appeared worse than the left due to presence of an eschar encompassing the entire wound bed. The right measured 25 cm 2 and the left 23 cm 2 .…”

“…22,23 Delivery of components within whole blood and the physical barrier provided by TABCT also assist in autolytic debridement, maintenance of a moist wound environment, and protection of the wound from pathogen entry and desiccation of exposed structures, further assisting in progression towards wound resolution. 17 TABCT has been shown to be safe and effective in the treatment of other complex wounds, including those with exposed bone and tendon, arterial compromise and exposed tendon and bone. 7,24,25 In an observational pilot study of 29 patients, 10% of which had PUs and almost half of which had wounds present for greater than 1-year duration reported a 4-week PAR of 65% and a 12-week PAR of 94%.…”

“… 6 These effects emphasise the major advantage of TABCT in progression of stagnant wounds from the inflammatory phase to the proliferative phase of wound healing. 17 TABCT also alters the secretion of extracellular proteases in the wound, preventing further distraction of the ECM. 22 , 23 Delivery of components within whole blood and the physical barrier provided by TABCT also assist in autolytic debridement, maintenance of a moist wound environment, and protection of the wound from pathogen entry and desiccation of exposed structures, further assisting in progression towards wound resolution.…”