The use of implantable acellular fish skin to augment lower extremity reconstruction

Introduction: Various allografts and xenograft have become more popular as implants to aid in tissue support. Limb salvage has seen an increase use of implants including, amniotic and dermal substrates. Recently acellular fish skin has gained FDA clearance for a similar application. Often there are lower extremity wounds that can be partially closed, but need further support, in many cases deciding on the right modulatory matrix difficult.

Methods: We present a prospective registry of lower extremity operations that were supplemented by the implantation of acellular fish skin. All patients were encountered in the operating room of a single tertiary care urban Medical Center. Follow-up were available at 1, 2, 4 and 8 weeks. No additional imaging was added as this was a prospective real world quality assurance evaluation.

Results: A total of 34 patients were reviewed. Eight patients were undergoing transmetatarsal amputation, 8 patients were undergoing below-knee amputation, 4 patients were undergoing rotational flap reconstruction of the foot. Six patients were post trauma patients in which tendon structures needed to be wrapped and protected from desiccation. In 4 cases joints were removed and the space intervening was filled with rolled acellular fish skin. The wounds were closed primarily over this construct. The last 2 patients were lower extremity lymphatic reconstruction patients in which VY advancement flaps or Z-plasties were being performed. The last 2 patients were wound dehiscence patients. Thirty two patients went on to heal by 8 weeks, in multiple cases if the wound was left partially open a hypergranular response was noted. One patient that had bone removal supplemented by implantation of acellular fish skin required reoperation and drainage of the wound.

Conclusion: While this in no way represents a prospective randomized evaluation of acellular fish skin, it does give a real world usage of potential applications for reinforcing areas that could benefit from enhance coverage of bony surfaces. The thin nature an compliance of the acellular fish skin allows it to conform to the spaces. Ideally additional imaging would be added to look at the deep tissue remodeling that occurs during this process.