Application of Fragmented Fish Skin Graft* on a Nonhealing Diabetic Foot Ulcer for a Diabetic Patient with Neuropathy and Chronic Kidney Disease

 Introduction: Fish skin graft (FSG) is a xenograft derived from Atlantic cod that augments wound healing1. This case evaluates FSG* in a patient with non healing diabetic foot ulcer (DFU) which had not responded to conservative wound care. Patient is a 67-year-old female with PMH of diabetes, neuropathy, chronic kidney disease (CKD), atrial fibrillation, hypertension, and hyperlipidemia. Need for non-conservative treatment arose as the wound persisted for over one month and risk of amputation developed.Methods: Patient is a 67-year-old female who presented with a persistent dorsal hallux wound on left foot. Imaging indicated bilateral peripheral vascular disease and vascular calcification. At initial visit, wound size measured 3.0 cm x 2.0 cm x 0.1 cm and underwent full-thickness biopsy and debridement; culture showed light growth of MSSA. Two weeks later, the wound measured 3.0 cm x 1.5 cm x 0.1 cm. Over the following month, the wound reduced to 3.0 cm x 0.5 cm x 0.1 cm but was still at risk for amputation. First FSG was applied, but was mistakenly removed six days later; reapplication of an initial FSG was performed the next week, with a wound measuring 2.0 cm x 0.5 cm x 0.1 cm. Two weeks later, the wound measured the same; a second FSG was applied. Third FSG was applied the following week; the wound measured 2.0 cm x 0.2 cm x 0.1 cm. After two weeks, the wound measured 1.0 cm x 0.3 cm x 0.1 cm and underwent a fourth FSG application. Fifth application was done three weeks later, with a wound measuring 0.5 cm x 0.25 cm x 0.1 cm. After eight days, the wound had closed.Results: Five applications over ten weeks augmented complete wound closure. This demonstrates the efficacy of using FSG on non healing DFU at risk of amputation. Five applications over ten weeks augmented complete wound closure. This demonstrates the efficacy of using FSG on non healing DFU at risk of amputation.Discussion: This case illustrates clinical efficacy in treating non healing DFU using FSG in a neuropathic female patient with CKD. FSG proved safe and effective in augmenting healing. More extensive studies should investigate FSG efficacy in treating DFU in patients with neuropathy and CKD.References:Di Mitri, M. (2023). Plastic & Reconstructive Surgery - Global Open, 11.