Acellular Fish Skin Prevents Re-Infection and Amputation in Exposed Bone Lower Extremity Wounds with History of MRSA and Chronic Osteomyelitis

Introduction:

Chronic osteomyelitis is the most common cause of amputations in diabetic foot ulcers. Reoperation due to persistent infection after surgical treatment is reported as high as 25%(1) A novel approach to reduce the risk of re-infections was tried combining a treatment with a) topical antibiotics in a sponge for the infection and b) an Acellular fish skin graft* rich in Omega3 to speed up the healing process.

Aim:

Evaluate the effect of a fish skin graft combination with an antibiotic impregnated bioabsorbable chitosan sponge# to heal wounds with history of chronic infection.

Cases:

1: 65 y.o. diabetic male with transmetatarsal amputation wound and osteomyelitis. Unresponsive to topical collagen dressing†. Treated with fish skin graft* and chitosan sponge# & impregnated with vancomycin and tobramycin. Healed in 20 weeks after with 6 applications of fish skin graft* and no incidence of reinfection

2: 68 y.o. non-diabetic male. Initial presentation with infected ulcer on his left heel and exposed bone with calcaneal osteomyelitis and maggots. Partial calcanectomy in O.R. Treated with fish skin graft* and chitosan sponge# with vancomycin. Healed in 12 weeks with 2 reapplications (3 total) of fish skin graft*, no instances of reinfection.

3: 70 y.o. male initial presentation with exposed bone and wagner 3 ulcer medial and lateral side of 3rd toe left foot. History of MRSA. Debrided bone in OR, chitosan sponge# with vancomycin and applied fish skin graft. The infection cleared completely after one debridement in the OR. Healed in 20 weeks after 1 further fish skin graft application, later had a BKA due to an unrelated issue.

Conclusion:

The unique benefits of the Omega3 rich fish skin grafts* can be used with topical antibiotics to combat infection. Initiating tissue regeneration and at the same time form a barrier to protect the wound from re-infections.