Injectable Hyaluronic Acid and Amino Acid Complex for Pediatric Hard-to-Heal Wounds: A Prospective Case Series and Therapeutic Protocol

Aim: To evaluate the feasibility, outcomes, and tolerability of an injectable hyaluronic acid plus amino acid (HA+AA) complex in children with hard-to-heal wounds. Background: Pedi-atric hard-to-heal wounds are rare but highly challenging due to skin immaturity, comorbidities, and the risk of infection. Hyaluronic acid (HA), a key extracellular matrix component, supports hydration, cell proliferation, and inflammation modulation. Its injectable formulation combined with amino acids (AA) essential for collagen and elastin synthesis may accelerate tissue repair in refractory lesions. Methods: A prospective observational case series was conducted in a special-ized pediatric wound care setting (November 2022–August 2025). Fifteen patients aged 4–16 years with wounds persisting >6 months were treated with HA+AA infiltrations, combined with stand-ardized wound hygiene and selected co-interventions (negative pressure wound therapy [NPWT], dialkylcarbamoyl chloride [DACC] dressings). The primary endpoint was time to complete re-epithelialization; secondary endpoints included pain and safety. Results: Complete healing was achieved in 14/15 patients (93.3%), with one patient censored at the end of follow-up. Median time to re-epithelialization was 6 weeks [IQR 5–12], with 50% healed by week 6 and >90% by week 12. The median number of infiltration sessions was 6 [IQR 5–12]; median follow-up was 14 months [IQR 8–24]. NPWT was required in 73.3% of cases, and DACC dressings in 20.0%. Treatment was well tolerated, with minimal procedural discomfort and no serious adverse events. Conclusions: Injectable HA+AA complex appears to be a safe, feasible, and potentially effective therapy for pe-diatric hard-to-heal wounds. While preliminary, these results support integrating HA+AA into multidisciplinary wound care strategies. Controlled multicenter trials are warranted to confirm efficacy and define optimal protocols.