The use of Kerecis to prevent double below knee amputation: case review

Introduction: Below knee amputations are a major cause for morbidity and mortality in the diabetic population. The five-year mortality rate after a below knee amputation is 40-82% with a 30-day mortality rate of 17%. Patients are facing not only mortality, but a decline in quality of life when experiencing a below knee amputation. Finding ways to treat diabetics with non-healing ulcerations can be difficult for the patient and physician. The longer an ulceration remains open increases the chances of infection, and this can lead to a below knee amputations. In this case, a fish skin graft was applied to heal a patient with venous stasis ulcerations who was facing bilateral below knee amputations. This fish skin graft has been shown to prevent below knee amputations that can prolong life and patient’s quality of life.Methods:An 84 y/o female with bilateral lower extremity ulcerations, with recommendations to have bilateral below knee amputations, is illustrated. Kerecis fish skin graft was applied to bilateral extremity after excisional debridement of ulcerations over a 3-month period. The grafts were left in place for one week and then re-examined after one week. Compression therapy was used in conjunction with the fish skin graft to reduce edema and aid healing.Results:After 3 months of weekly Kerecis applications, the patient’s wounds were completely healed. This patient started off with ulcerations measuring 10cmx8.5cmx0.9cm on the right lower extremity and 6.0cmx6.5cmx0.8cm on the left lower extremity. Both wounds were 100% necrotic and fibrotic with purulent drainage. After one application the right wound measured 9.7cmx6.7cmx0.5cm and the left wound measured 5.6cmx4.9cmx0.5cm, and there was now healthy granular tissue to both wounds with mild serous drainage. After 3 months of compression therapy and fish skin grafting, both wounds were healed. The patient’s limbs were salvaged after being told she would possibly lose both of her legs.Discussion: This patient was able to have both limbs salvaged after having Kerecis fish skin grafts applied. This patient’s risk of mortality was as high as 82% in 5 years if she had bilateral below knee amputations. The patient’s quality of life would have declined with below knee amputations, and she would have remained in a skilled nursing facility. Ultimately, the amputations would have been a financial burden on the patient to remain in a skilled nursing facility. After weekly debridement, compression therapy and application of Kerecis grafts the patient was able to keep both limbs.References: