Fish Skin Graft for Closure of Complex Stage 4 Pressure Wounds of Trunk in Non-Operative Patients in the Outpatient Setting

Introduction: Treatment of complex pressure wounds especially those with tunnelling and undermining can be challenging. In many cases, operative debridement and complex closure with a flap is required to achieve a durable closure. We report a case series of closure of three stage 4 pressure wounds of the trunk in the outpatient wound care setting with the aid of Fish Skin Graft (FSG).Methods:Three patients with complex stage 4 pressure wounds of sacrum and ischium with tunnelling and undermining.  They were deemed to be patients that were not operative candidates due to high-risk nature of their co-morbidities and so as an alternative to the standard debridement and flap closure in the operative setting FSG was used to achieve closure of these wounds in an outpatient clinic.Results:All three patients achieved durable closure of the wounds with serial debridement, offloading, advanced wound care and applications of FSG. Discussion: FSG is a novel biologic skin substitute to assist in closure of complex wounds in the OR and out. This case series demonstrates that FSG is an additional tool to assist in non-operative closure of complex wounds that traditionally require surgical intervention.  In fact, these closures resulted durable scars even over weight bearing areas.References: