Dealing with a general docx file, especially one produced by Word, is difficult because Microsoft don't follow their own specs in all cases. Usually, most specific cases are easier - it's perfectly possible to produce valid, well formatted docx documents using e.g. Template::Toolkit and Archive::Zip, since docx files are just zipped xml at heart.

I have no knowledge of SQL Server BLOB formats, but it might be worth trying to unzip the .docx file you produce to see if:-

1. It's a valid zip file.
2. It contains stuff that looks like xml

If it doesn't look anything like a zip file, you probably need to do some more processing on the BLOB before writing it to file; if it looks docx-ish, you just have to work out what changes you need to make Word eat it.