Application of Fragmented Fish Skin Graft* on Nonhealing Diabetic Foot Ulcers for a Diabetic, Wheelchair-Bound Patient with Neuropathy and Previous Stroke

Introduction: Fish skin graft (FSG) is a xenograft derived from Atlantic cod that augments wound healing1. This case evaluates FSG* in a patient with nonhealing diabetic foot ulcers (DFU) which had not responded to conservative wound care. The patient is a 67-year-old, wheelchair-bound male with PMH of diabetes, neuropathy, stroke, hypertension, and hyperlipidemia. Need for non-conservative treatment arose as wounds persisted for over one month and risk of osteomyelitis and/or amputation developed.Methods:The patient is a 67-year-old, wheelchair-bound male who presented with nonhealing DFU on 2nd, 3rd, and 4th digits of left foot. At the initial visit, wound measurements were: 2nd digit - 1.0 cm x 0.5 cm x 0.1 cm; 3rd digit - 1.5 cm x 1.0 cm x 0.1 cm; 4th digit - 1.0 cm x 0.5 cm x 0.1 cm. Wound underwent full-thickness biopsy and debridement. Two weeks later, 4th digit wound had closed, 2nd digit wound measured 1.5 cm x 0.5 cm x 0.1 cm, and 3rd digit wound measured 1.0 cm x 1.0 cm x 0.2 cm. 3rd digit was debrided; culture showed moderate growth of MRSA. High risk for amputation necessitated FSG. Wound measurements the following month were 1.0 cm x 1.0 cm x 0.1 cm for 2nd digit and 1.0 cm x 1.0 cm x 0.5 cm for 3rd digit; FSG was applied to each. The following week, 4th digit wound was closed. 3rd digit wound measured 1.0 cm x 1.0 cm x 0.1 cm; FSG was applied. After eleven days, 3rd digit wound measured the same and underwent final FSG application. Two weeks later, wound closed.Results:Four applications of fragmented fish skin graft over five weeks augmented complete wound closure. This demonstrates the efficacy of using FSG on nonhealing DFU at risk of amputation.Discussion: This case illustrates clinical efficacy in treating nonhealing DFU using FSG in a wheelchair-bound, neuropathic male patient with previous stroke. FSG proved safe and effective in augmenting healing. More extensive studies should investigate FSG efficacy in treating DFU in wheelchair-bound patients.References:1. Di Mitri, M. (2023). Plastic & Reconstructive Surgery - Global Open, 11.