Autologous Treatment in Limb Threatening Diabetic Foot Wounds: A Trifecta of Autologous Fibrin, Leukocytes and Platelets in Fifteen Patients

Objectives: The investigators of this study provide an analysis of fifteen patients treated with an autologous patch consisting of fibrin, leukocytes and platelets. These patients have failed conventional treatment for diabetic foot wounds, consisting of local wound care, sharp debridement and offloading using a total contact cast system.

Background: The effects of fibrin and growth factors found in autologous plasma have been documented in wound healing and the formation of collagen. The autologous combined leucocyte, platelet and fibrin patch, is a novel treatment created by a unique centrifugation of autologous blood. The patch is applied to chronic diabetic foot wounds that have failed conventional wound care treatment alone.

Case Description: In this investigation, fifteen patients have failed at least four weeks of conventional wound care (average 16 weeks). These patients continued to have a wound size of more than fifty percent of their original size at four weeks, despite weekly sharp debridements, local wound care and total contact cast offloading. All patients presented with type II diabetes, peripheral arterial disease (diagnosed as having a peripheral vascular procedure within one year and/or on conventional anticoagulation medication). Four patients were on hemodialysis. The patch was applied weekly, one to seven applications (mean five) per patient were done. Patient age range was 37-89 years old (mean 59). Wound sizes were analyzed weekly utilizing a digital wound imaging software. In this patient population, it was determined that after one application of a patch, in conjunction with sharp debridement, local wound care and adjunctive total contact casting, the average decrease in length was 25.89%, width decrease was 18.84%, depth decrease was 6.64% and total surface area decrease was 25.31%.

Conclusion: In our case series of fifteen patients, the use of the autologous patch, in conjunction with local sharp debridement and offloading measures (total contact casting), has shown to decrease the sizes of diabetic foot wounds on a weekly basis, especially in the setting of chronic wounds lasting more than four weeks duration. Of the fifteen patients evaluated, six patients completely healed (complete epithelialization) with the use of the patch during the eight week evaluation period.