Fish skin graft use in open wounds associated with Olecranon Bursitis

Introduction: This is a case of using Fish Skin Graft (FSG) on a large open wound complicated by olecranon bursitis.  The patient is a right handed 87 yr old male avid fisherman with history of facial/esophageal metastatic squamous cell cancer (SCC).   He presented to the Wound Clinic in early July with 2 painless quarter sized ulcers covered with eschar surrounded by erythema and edema over the right olecranon. He did not want a surgical opinion regarding his right recurrent olecranon bursitis and wounds.  Methods:He was initially started on standard of care treatment biweekly with debridement, hydrofera blue, and applications of both the 3M Activac x 2 sessions and manual snap vacs to increase blood flow, reduce edema, and promote granulation tissue in the wound bed.  The first debridement merged two wounds into one with a depth down to the fascia. For the initial 4-6 weeks, FSG applications were applied as micro or in sheets and alternated weekly with application of a SNAP Vac to control edema and promote contraction of the wound. A total of 10 fish skin graft applications were used over 3 months from September through end of December.  All applications were done at the Wound Clinic.Results:The wound closed within 3 months after 10 applications total.  Final photos taken in May the following year.  Each month, his measurements decreased by 1 cm until closure by end December.   The swelling from his bursitis never restricted movement and the open wounds remained pain free.  The patient healed without contractures or decreased range of motion.  He never developed a fever or sepsis.  He did not require skin grafting nor admission to the hospital.  His scar remained intact and pliable.Discussion: Olecranon bursitis is common and typically occurs in men between ages of 30 and 60 years old.   Close to 70% of bursitis cases are non-septic and related to repeated trauma or sports injuries leading to bleeding and inflammation (NIH, StatPearls, Jon Pangia; Tara J. Rizvi, June 12, 2023).   Recurrence rates are difficult to quantify as bursitis is mainly treated in outpatient areas and is not tracked.  This is an atypical case of aseptic olecranon bursitis in an 87 yr old male who is nondiabetic and immunocompromised. The use of FSG demonstrated its success at healing this type of inflammatory wound.  He was very pleased with his results and the bursitis did not reoccur.References: