Fish Skin Grafts for treatment of difficult to heal chronic wounds

Introduction: Patients with comorbidities such as diabetes mellitus, Crohn's disease, peripheral vascular disease and lymphedema must overcome considerable hurdles during the wound healing process such as immunosuppression/compromise, recurrence, chronic poor perfusion and skin graft failure.

Acellular fish skin grafts* contain omega-3 polyunsaturated fatty acids, which reduce inflammatory responses and advance cytokines to promote wound healing; these grafts should therefore mitigate some of the effects of these comorbidities. A series of patients are presented with a number of chronic wounds which have failed optimal standard wound care or a high predisposition to poor wound healing due to immunosuppression and malnourishment.

Methods: Three patients presented: a 64 year-old-male with type 2 diabetes and a pressure ulceration on his heel; a 40-year-old male with anastomotic leak secondary to Crohn's, and a 67-year-old female with a venous insufficiency wound secondary to lymphedema. All were treated with wide excisional debridement, applications of human amniotic tissue, and negative pressure therapy, and application of an acellular split thickness fish skin graft.

Results: The 40-year-old male's skin graft and the 64-year-old had a take of around 65% and the 67-year-old female's graft took 100% with no evidence of surrounding separation. Both male patients experienced difficulty with follow-up during COVID; one developed a small bowel fistula secondary to his Crohn’s which prevented full wound closure, and one was lost to follow-up.

Discussion: Acellular fish skin grafts are applicable in a wide range of disease processes with consistent, durable results. Further research is warranted.