Advancing healing in large hard-to-heal wounds: the ripple effect of autologous whole blood clot therapy: a case series

Objective: Hard-to-heal (chronic) wounds of the lower extremity, particularly large-area wounds, present significant challenges due to their usually prolonged healing time and complications that might lead to surgical interventions, adding to the high burden on the healthcare system. This study aimed to evaluate the efficacy of autologous whole blood clot (AWBC) therapy in promoting healing in large (>28cm 2 ), hard-to-heal wounds. Method: Patients with a mean wound size of 63.4±31.6cm 2 were treated weekly with AWBC therapy. AWBC was created from a small blood sample of the patient and applied weekly onto the wound, covering only part of it (the clot size is 28cm 2 , and only one was used). The patients were followed until complete wound closure or satisfactory healing was achieved. Results: This case series comprised 27 patients (55.5% female, mean age: 69.7±15.8 years). The results showed that 78% of the treated wounds progressed toward healing, with an overall mean percent area reduction of 74% at the final follow-up. AWBC therapy demonstrated a high level of efficacy across all wound types, showing effectiveness even when the clot did not fully cover the wound area. Conclusion: In this case series AWBC therapy offered a promising solution for large, hard-to-heal wounds by creating a favourable microenvironment that promoted tissue repair. The therapeutic effect extended beyond the area directly covered by the clot, suggesting a ripple effect mediated by bioactive factors from the clot. AWBC therapy represents an innovative and effective treatment option for large, hard-to-heal wounds. While additional studies are needed to optimise protocols and further investigate the underlying mechanisms, these findings demonstrate AWBC therapy's ability to address the limitations of existing wound care strategies.