Novel Application of Fish Skin Grafts in Complex Vascular Wound over Knee Joint

Introduction: Wounds in vascular patients often pose unique concerns when approaching options for treatment.  Whereas such wounds are inherently acute in nature, wound management in this unique patient population must consider the long-term effects of treatment that will affect the future function of the limb and the aesthetic qualities of a residual scar later in life. Identifying safe and effective dressings to treat complex wounds in this fragile population is often a challenge for vascular wound care specialists. In this case, an intact fish skin graft (FSG) was applied to a complex knee joint wound that probed down to his patella with high risk for limb loss and successfully allowed for complete restoration of function to his limb with no contracture.Methods:A 59-year-old male with a history of hypertension, dyslipidemia, COPD, coronary artery disease, presented to the hospital with severe rest pain in his lower extremities as well as abdominal pain.  He underwent workup including a CT scan that showed he had ischemic changes to his left colon and an occluded infrarenal abdominal aorta.  He subsequently required to undergo a left colon resection with end colostomy for his ischemic bowel. He underwent Aorto-bifemoral bypass with aortic endarterectomy, and bilateral superficial femoral, common femoral and profunda endarterectomies. He presented to the wound care center for evaluation of his complex wound with concern for contracture of the knee.Results:Patient required extensive vascular reconstruction of his peripheral vascular disease and then subsequently underwent extensive debridement of his knee wound that probed down to the patella.  A total of 7 applications of Kerecis Marigen (powder and fenestrated graft) with healing of his wound.  Patient had no contracture and went from being wheelchair bound to walking without assistance (back to baseline). Discussion: This case series illustrates the complex nature of peripheral vascular patients that requires a staged approach to help with careful attention to mobility and functional status.  Patient presented with a complex situation with GI and vascular problems that required a staged approach to give him the best long-term outcome.  Unfortunately, this can lead to significant debilitation and subsequent development of wounds.  This patient presented with a large knee eschar with carried a high risk of limb loss.  However, with a multidisciplinary approach, extensive rehabilitation, and weekly wound care using Kerecis Marigen graft, the patient was able to get back to his functional status with complete healing of his wounds.References: