Fish Skin Graft: A promising treatment for managing anal fistula pre and postop complications

Introduction: Anal fistula is an infected tunnel between the skin and anus, the muscular opening end of digestive tract. Most anal fistulas are result of infection in anal gland spreading to skin. Symptoms: pain, swelling, discharge of blood/pus from anus.  Surgery usually needed. Fish skin graft (FSG)  a unique biologic scaffold resembles dermal extracellular matrix. Rich in Omega3 anti-inflammatory, promotes cellular ingrowth, neovascularization and aids tissue infill and remodel. Hypothesize that FSG, can be used as part of the surgical intervention for anal fistulas aiding in tissue formation, vascularization and cellular ingrowth.Methods:Two patients with anal fistulas underwent fistulectomy. 38 y/o male and 28 y/o male presented with intersphincteric and complicated transphincteric fistulas, respectively, treated operatively. They  underwent excision and treated with FSG packed into the sinus. Results:Patient one:  no signs of erythema, minimal drainage. Incision displayed advanced healing seven days postop. Day eighteen, continued healing observed, no complications. Day thirty-nine,  incision was fully healed complication-free. Patient two: Day fourteen, remarkable incisional regeneration with little drainage or pain. Day fifty-three, healed and presented no complications.Discussion: Anal Fistulas have high prevalence/incidence rate. Treatment goals: manage pain, infection, sepsis, promote sinus tract healing and preserve sphincter function. Postop reoccurrence rates high, we need  new treatment options. FSG appears to attenuate inflammation/secondary infection while rapidly regenerating  sinus tract. FSG has inherent Omega3 fatty acids, low immunogenicity, and is homologous to the human dermis in mechanical and biological content. Rapid regeneration of the anoderm, reduced infection, and preserved sphincter function were seen.References: