Time to Lower Extremity Wound Closure with the Use of Acellular Fish Skin Compared to Negative Pressure Wound Therapy

Introduction: After foot resection, there are multiple ways of dealing with bony exposure, poorly vascularized, and infected tissue. One of the most common being negative pressure wound therapy (NPWT). However, recent attempts to further decrease length of stay or length of NPWT have led to attempted use of cellular or tissue based therapies.

Purpose: We decided to look at acellular fish skin and a dosing schedule for application of cellular tissue based therapy.

Methods: With 24 hours of resection of diabetic foot wounds that require intravenous antibiotics for foot sepsis, we applied the first applicatino of acellular fish skin. The dosing schedule for further application was Day 1, 4, 11, and 18. This was done without the addition of NPWT.

Results: A total of 4 patients were investigated on this application schedule, which showed early granulation tissue and appropriate reduction length of stay. Obviously, there was a reduction in NPWT since we did not use it. The average time to closure was compared to a large retrospective database listing times to closure

Discussion: When using biologic agents, we often do not look at dosing schedules, which is probably not appropriate. Modulatory cellular and tissue based therapies have the potential to reduce the inflammatory cascade early on application and be able to sustain longer intervals between re-application.

Conclusion: This is an initial attempt at evaluating such dosing schedules using clinical endpoints, instead of biologic markers.