Healing Tunneling Wounds by Layering Fragmented Fish Skin Graft (FSG)

Introduction: Healing tunneling wounds is particularly challenging due to their complex structure and the difficulty in accessing the entire wound area for treatment. Tunneling wounds, which extend deeper into the tissue than their surface area suggests, create narrow channels that can harbor bacteria and debris, leading to a higher risk of infection and delayed healing (1).   FSG can be applied in layers due to their unique structural properties that facilitate effective wound healing. The natural collagen matrix in codfish skin provides a biocompatible scaffold that supports cellular infiltration and tissue regeneration (2). This layered application allows for better conformity to the wound bed, ensuring that deeper tissues receive the necessary support and protection. Furthermore, layering helps manage exudate and maintain a moist wound environment, which is crucial for optimal healing (3). Lastly, the layering ensures there is no dead space within the wound thus preventing the formation of a hematoma or a seroma.   The purpose of this study is to present three different types of tunneling wounds of varying sizes, each due to a different etiology, that were healed successfully by layering the fragmented FSG upon itself.Methods:The wounds were debrided and fragmented FSG was subsequently applied. Negative Pressure wound therapy was utilized in two of the three cases, and was discontinued in those patients after the wounds were superficial. Collagenase ointment was applied twice a day once the wounds were superficial.  Results:All three wounds were healed completely without any complications.  Discussion: Most dermal substitutes cannot be layered upon itself, which presents a challenge when encountering wounds that tunnel. The unique properties of FSG make it vastly different from the other grafts in the market, as it can be applied in layers up to the brim of the wound. Further replication of the use of FSG in this manner is warranted to solidify it as a valid standard of care for tunneling wounds.References:1. Edwards, J., & Stapley, S. (2010). Debridement of chronic wounds: A systematic review. Journal of Wound Care, 19(2), 53-56. 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. 3. King, A., Stellar, J. J., & Blevins, A. (2020). Fish skin grafts in wound healing. Plastic and Reconstructive Surgery - Global Open, 8(5), e2902.