Healing Pedal Wounds due to Negligence at Extended Care Facilities with Fish Skin Graft (FSG) and Sterilized Honey (SH)

Introduction: Negligence in extended care facilities is a critical issue that can lead to severe harm or even death for residents. Studies have shown that these lapses lead to increased rates of infections, falls, and medication errors among residents amongst many other complications (1).   One of the most common complications are wounds.  FSG and SH have their wound healing capacities well documented, however no study yet has evaluated their usage together. The synergistic interaction between honey and codfish skin likely arises from their complementary mechanisms of action, including antimicrobial activity, anti-inflammatory effects, promotion of tissue regeneration, and moisture retention. (2,3) The purpose of this study is to start a conversation about the current state of care (or lack thereof) at extended care facilities as well as to show the efficacy of healing wound complications with the combination of FSG and SH.Methods:In the first case, the patient had a pedal amputation and at the first follow up visit his dressings were saturated in his own urine (as they did not change him at the facility). This resulted in maceration of the incision and wound dehiscence. In the second case, the patient had elective orthopedic surgery and had to be sent to a facility as she could not use crutches or a walker. She eventually developed a decubitus heel ulcer on the contralateral side due to not being repositioned or adequately offloaded with pillows or a foam boot. The wounds in each case were debrided and FSG and SH were subsequently applied. The wounds were fenestrated at weekly visits to allow sanguineous saturation into the incorporating graft and SH was again applied.Results:After only one application of FSG the wounds healed and epithelialized without any incidents.  Discussion: This study displays the ability of the FSG/SH combination to heal wounds with efficiency. Further trials evaluating the combined therapy would provide valuable insights into its mechanisms of action. However, these pathologies would not have occurred if the primary problem was already addressed. Addressing these issues requires stringent regulatory measures, increased staffing and improved training programs to ensure the safety and well-being of vulnerable populations (4).References:1. Smith, J., & Brown, L. (2022). Negligence in extended care facilities: Causes and consequences. Journal of Elder Care, 45(3), 234-245. 2. Cooper, R. (2016). Honey for wound care in the 21st century. Journal of Wound Care, 25(9), 544-552. 3. 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. 4. Goldman, D. P., Kane, R. L., & Ouslander, D. (2011). Will increased staffing improve quality of care in nursing homes? The Gerontologist, 51(1), 64-76.