The Application of Fish Skin Graft in Nutritional Skin Failure Syndrome: A Four Patient Case Series

Introduction: Human skin is a vital part of the body's immune system, forming a physical barrier between external and internal environments. Adequate nutrition is required for this active immune organ to perform its physical barrier function. The growing incidence of chronic non-healing wounds in aging and indigent populations may result from a culture of poor nutrition, in what the author calls nutritional skin failure syndrome The dermal application of minimally intact fish skin graft (FSG)* allows for the deposition of collagen and Omega3 to the wound, aiding in reducing inflammatory response as well as providing nourishment to the skin, allowing for improvement in the environment that led to the chronic wound in the first place. A four-patient case series evaluated the feasibility of intact fish skin as a method of topical nutrient delivery to the skin.

Methods The intact FSG was used to promote healing in four patients presenting with nutritional skin failure syndrome, as demonstrated by chronic and acute non-healing lower extremity ulcers. The FSG was applied as per the manufacturer's instructions. The patients received weekly to biweekly applications of FSG depending on wound state. Patients varied from 41 to 92 years of age; wound etiology included peripheral artery disease, diabetes, surgical excision of osteomyelitis, ulceration after deep vein thromboembolism secondary to COVID infection.

Results: On average, five applications of FSG were required for definitive wound closure. The oxygenation of the wound bed had improved by day seven post FSG application and continued to improve at day 21. Wounds showed improved blood flow and delivery of oxygen-rich nutrients to the skin, which aided in wound healing processes. Definitive wound closure was achieved in all patients. The Omega3 fatty acid content potentially supports a more nutritionally nourishing wound healing environment. Therefore, the topical replacement may help mediate inflammatory markers, allowing the wound healing continuum to restart

Discussion: The population most often experiencing chronic wounds is the same population that socioeconomically cannot bear them. Addressing the nutritional depletion of these wounds may be beneficial both topically and systemically, and further study of nutrition as both treatment and prophylaxis should be performed.