A Novel Application of Fish Skin Graft for Reinforcement of Transtibial Amputations

Introduction: To evaluate the efficacy of a novel tissue reinforcement using fish skin graft (FSG) to improve the healing of transtibial amputations, decrease the rate of amputation revision, decrease the time to prosthetic fitting, and improve limb durability.Methods: A retrospective review was performed on 57 consecutive patients who underwent primary transtibial amputation (TTA) that utilized FSG tissue reinforcement. An acetabular reamer was used to obtain bone graft from the proximal aspect of the resected tibia. The bone graft was applied to a 7x10 cm FSG solid sheet and folded in half lengthwise. FSG micro was applied to the residual limb soft tissue and the FSG sheet with enclosed bone graft was secured with sutures to the tibia and fibula. A circumferential negative pressure wound vacuum dressing was used for the postoperative dressing.Results: The study cohort data showed an incisional dehiscence rate of 8.8% (5/57 patients) 90 days postoperative. The 1996 Centers for Medicare and Medicaid Services reports an incisional dehiscence rate from 26% to 34.5%. (1)   The study cohort mortality was 5% (3/57) within the first 90 days. Mortality rate within the first 90 days averaged 18% nationally. (2)   Prosthetic fitting occurred approximately 3 months after surgery. This compares favorably to the Veterans Administration prosthetic fitting of 4 months.Discussion: The use of FSG for reinforcement of TTA demonstrates a decreased revision rate, decreased time to prosthetic fitting, and decreased mortality. The FSG also created a synostosis between the tibia and fibula. The synostosis between the tibia and fibula is encouraging for potential improved long term viability of the residual limb. References: Dillingham TR, Pezzin LE, Shore AD. Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations. Arch Phys Med Rehabil. 2005;86(3):480–86. Jason K. Gurney, James Stanley, Juliet Rumball-Smith, Steve York and Diana Sarfati. Death After Lower-Limb Amputation in a National Prevalent Cohort of Patients With Diabetes. Diabetes Care 2018 Jun; 41(6): 1204-1211.