(CS-102) Durable Wound Closure in Smokers Using an Autologous Multilayer Leukocyte-Platelet-Fibrin Patch: A Case Series

Friday, April 10, 2026

Ashley Sonney, FNP-BC, ACHRN, WCC – Director of Clinical Services, Wound Care, LECOM

Introduction: Chronic wounds in patients with a history of tobacco use present a significant clinical challenge due to smoking-induced vasoconstriction, endothelial dysfunction, impaired nitric oxide signaling, and persistent tissue hypoxia. These pathophysiologic effects impair angiogenesis and oxygen delivery, resulting in delayed healing, failure of standard wound therapies, and high rates of wound recurrence. Autologous multilayer leukocyte-platelet-fibrin patch (MLPF; 3C Patch) is a biologic therapy that supports cellular migration, immune modulation, and sustained release of growth factors without exogenous additives. Prior studies have demonstrated that autologous MLPF provides a stable, angiogenic effect capable of supporting healing in recalcitrant wounds.¹

Methods:

This case series evaluated five patients with active or recent smoking history and complex lower-extremity wounds treated at a single wound care center. Wound etiologies include diabetic foot ulcers and post-amputation stump wounds, many complicated by peripheral arterial disease, chronic kidney disease, prior amputations, diabetes, and failure of advanced wound therapies. Several patients had critically impaired arterial disease.

Patients received serial applications of MLPF patch prepared from their own blood. Adjunctive therapies including hyperbaric oxygen therapy (HBOT), vascular intervention, offloading, infection management, and glycemic optimization, were utilized as indicated. Outcomes were assessed and included wound progression, achievement of closure, limb salvage, and durability of closure.

Results: Prior to initiation of MLPF therapy, all wounds demonstrated stalled or declining healing trajectories despite prolonged treatment and advanced wound care. Following the MLPF application, progressive granulation tissue formation, improved wound tissue quality, and epithelialization were observed. MLPF was applied a mean of 11 times (range: 5–20). All five wounds achieved complete closure, including cases in which major amputation had been considered. Limb salvage was achieved in all applicable patients, and all wounds remained closed at follow-up despite ongoing vascular disease and the known risk of recurrence in smokers.

Discussion: This case series of smokers with complex, refractory wounds, autologous MLPF (3C Patch) therapy was associated with sustainable wound closure and limb preservation. By providing an angiogenic, cell-rich biological patch capable of functioning in hypoxic tissue, autologous MLPF may address key pathophysiologic barriers to healing in smokers and represents a clinically relevant therapy when standard wound therapies fail.