Application of Fragmented Fish Skin Graft* on Nonhealing Diabetic Foot Ulcers for a Diabetic Patient with Congestive Heart Failure

 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 ulcers (DFU) which had not responded to conservative wound care. Patient is an 88-year-old female with PMH of diabetes, congestive heart failure (CHF), depression, hypertension, hyperlipidemia, thrombocytopenia, hypothyroidism, anemia, and peripheral arterial disease (PAD). Need for non-conservative treatment arose as wounds persisted for over one month and risk of osteomyelitis and/or amputation developed.Methods: Patient is an 88-year-old female who presented with non healing DFU on 3rd digit of left foot and 5th digit of right foot. At the initial visit, the left foot wound measured 1.0 cm x 0.5 cm x 0.1 cm, right foot wound measured 1.75 cm x 1.0 cm x 0.1 cm. Imaging indicated 40% stenosis of the right common femoral artery, vascular calcifications, and PAD. Wound underwent full-thickness biopsy and debridement. One week later, the left foot wound had closed while the right foot wound measured 1.5 cm x 1.5 cm x 0.1 cm. Culture was positive for MRSA colonization, necessitating FSG to accelerate healing. FSG was applied at the following visit two weeks later, where the wound measured 1.0 cm x 0.8 cm x 0.1 cm. Second FSG was applied the following week, with a wound measuring 0.5 cm x 0.5 cm x 0.1 cm. Third FSG was applied two weeks later, with a wound measuring 0.6 cm x 0.4 cm x 0.1 cm. After two weeks, the wound was 0.5 cm x 0.1 cm x 0.1 cm and underwent a fourth FSG application. Complete closure was achieved nine days later.Results:Four applications over seven 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 diabetic female patient with CHF. FSG proved safe and effective in augmenting healing. More extensive studies should investigate FSG efficacy in treating DFU in patients with CHF.References:Di Mitri, M. (2023). Plastic & Reconstructive Surgery - Global Open, 11.