The use of Acellular Fish Skin for the Treatment of C6EnAnPn Chronic Venous Ulcer Disease

Introduction: There is relatively little written about the active venous ulcer that does not have; a good venous cause, no venous location identified and no venous pathophysiology identifiable. Using the CEAP classification; as outlined by Eklof et al (2004); these patients would be classified as C6,En,An,Pn. These patients usually have lipodermatosclerosis with a setting of an ulcer in the appropriate location; some of these patients are simply morbidly obese, and/or have sleep apnea and very poor ankle goniometry. One must also evaluate them for rheumatologic and hematologic disorders.

Methods: We present a retrospective review of prospective chart analysis of patients who are noted to be C6,En,An,Pn , and had negative rheumatologic and hematologic evaluations for any known factors that may contribute to skin ulceration. All these patients had detailed venous duplex, and were on pentoxifylline 400 mg 3 times a day, and were prescribed physical therapy for range of motion. In addition, we present a care algorithm that included a debridement with placement of acellular fish skin in the operating room, followed by weekly applications of acellular fish skin until closure or for 8 consecutive weeks. The placement of acellular fish skin is done in conjunction with multilayer compression and nonstick coverage.

Results: A total of 24 patients were treated over a 16 month period. There median age was 66 years, 22 were female, 20 identified as Black, for identified as Latino. The median wound area at starting was 34 sq cm. The median number of applications of acellular fish skin was 8 over a 8 week period. The median area reduction was 66%, with 50% closure at 12 weeks.

Conclusion: Patients with venous leg ulcers should undergo algorithm care that includes improvement of their venous outflow with appropriate intervention up to and including surgery, the use of multilayer compression, pentoxifylline as well as a graded exercise program should result in 50% wound closure at 12 weeks. For those patients who do not have venous pathophysiology that can be modified alternative therapies including the early utilization of tissue based therapy can be beneficial.