Fish Skin Graft (FSG) to Heal a Wound Secondary to Complication from a Rotational Skin Flap in the Plantar Foot

Introduction: Although a primary closure of wound via a rotational skin flap is ideal in terms of conserving time and getting an individual back to their daily life earlier, it comes with the downside of increased morbidity. Common complications from performing pedal rotational skin flaps include partial flap necrosis, wound dehiscence, infection, and delayed healing with a prevalence of complication rates ranging from 10-30% (1).   FSG has been popularized over the past few years due it its cost effectiveness compared to other grafts, but more importantly due to its relative speed and efficacy in healing wounds (2). The goal of this study is to display how effective the FSG is when dealing with surgical wound healing complications and to propose it as a viable alternative to local skin flaps.Methods:The patient had a painful hemangioma at the plantar foot for which a rotational skin flap was performed. At the follow up visits partial flap necrosis was observed and was allowed to demarcate after which the necrotic tissue was excised, the underlying wound was debrided. FSG was then applied with Negative Pressure Wound Therapy (NPWT). At subsequent follow up visits, the remaining incorporating graft tissue was fenestrated to allow for sanguineous saturation into the graft and NPWT was re-initiated. NPWT was discontinued at 4 weeks and collagenase ointment was applied daily in the morning and becaplermin ointment was applied daily at nighttime.Results:After only one application of FSG, complete healing of the wound was noted at seven weeks, without any complications.  Discussion: The effectiveness of today’s dermal substitutes makes surgeons reconsider relatively aggressive plastics techniques to primarily close open wounds. Although the wound healing process utilizing this option is significantly longer, its morbidity is also markedly lower than performing a local flap. In hindsight, this author believes that he should’ve excised the soft tissue mass and healed the subsequent open wound secondarily with the use of FSG, and used the rotational skin flap had the primary treatment plan failed. The hope is that other providers learn from this case’s mistake and initially choose the less aggressive option when encountering a similar pathology.References:1. Huang, C. T., Chen, H. C., & Lin, P. Y. (2010). Reconstruction of the plantar aspect of the foot with various local fasciocutaneous flaps. Clinics in Plastic Surgery, 37(1), 127-137. 2. Guðbjartsson, T., Sigurjónsdóttir, Á., & Þórðarson, H. (2021). The use of Icelandic codfish skin for wound healing: A review. International Journal of Biomaterials, 2021, 1-8.