Use of Fish Skin Xenograft to Assist Management of Wounds in Patients with Peripheral Vascular Disease

Introduction: Patients with peripheral vascular disease usually present with wounds which are difficult to heal per the literature. Traditionally, these are wounds which are not receptive to graft treatments due to the risks for colonization of bacteria or lack of blood supply to assist with full incorporation. Fish skin xenografts were applied on patients with peripheral vascular disease as a means to attempt to assist with healing.Methods:Thirty-six patients with wounds were included in this study. Co-morbidities included but were not limited to Diabetes Mellitus, Peripheral Vascular Disease, Congestive Heart Failure, and Chronic Kidney Disease. There were four patients which were transplant patients. All patients were optimized based on their need for other medical specialties and management. All patients were cleared by their Vascular service to proceed with graft procedures as these patients were maximally revascularized. All patients had up to date vascular studies which revealed mild to moderate lower extremity arterial insufficiency which were recorded within one month prior to graft application. Each patient underwent wound graft procedures using fish skin xenograft.Results:Thirty-one of thirty-six patients went on to heal fully with fish skin xenograft application. Applications ranged from one to four applications. The average time to healing was 10.2 weeks. Wound sizes ranged from 1.2 cm x 1.0 cm x 0.2 cm to 15.3 cm x 10.3 cm x 1.0 cm. Two patients who failed to heal their wounds went on to proximal amputation. These patients were in the moderate lower extremity insufficiency group with one of them progressing to severe insufficiency. Nineteen of the thirty-one healed patients had mild arterial insufficiency while twelve has moderate arterial insufficiency. No patients had improvement in their vascular status or further intervention during and after skin grafting procedures. All thirty-one patients remained healed with an average follow up of 9.3 months at the time of submission. There were no instances of infection following the procedures and throughout management.Discussion: Fish skin xenografts provide a viable option for skin grafting in patients with peripheral artery disease upon clearance from Vascular surgery following optimization.References: