Use of Acellular Fish Skin Graft for a Surgical Wound After Postoperative Infection with Exposed Hardware

Post-operative infection with exposed hardware is often difficult to manage. After the acute infection has been resolved, there is still concern about coverage for the bone and exposed hardware. Tissue grafting, flap closure, and negative pressure therapy have been some of the traditional options.

A 57-year-old female with a history of hypothyroidism and arthritis presented two weeks status post forefoot reconstructive surgery with a dehisced incision secondary to weightbearing status noncompliance that led to hematoma development and subsequent full thickness wound. Patient was placed on an oral antibiotic and local wound care was attempted for 4 weeks including a collagenase and dressing regimen. Due to exposure of hardware and failure of improvement of local wound care the first application of an acellular fish skin graft* was applied. Granulation tissue over the hardware was noted 14 days following initial application. Following the initial application of the acellular fish skin graft, patient had 5 additional applications every 2 weeks until complete epithelialization. Complete wound healing with minimal scar contracture was obtained 101 days after initial application of graft.

Post operative surgical infections with exposed bone and hardware can be challenging to get adequate soft tissue coverage once the infection has been resolved. When bone and hardware are exposed, the risk for developing osteomyelitis is significantly increased [1]. A piscine graft provided a thick extracellular wound matrix that allowed for quick coverage of the bone and hardware with granular tissue. Thus, providing the wound bed with a thick extracellular matrix that promotes faster ingrowth of capillaries and dermal cells. There is increased thickness of grafts allowing for a more porous structure and less of an immune response compared with other grafting techniques.

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References (if applicable): 1. Schmitt SK. Osteomyelitis. Infect. Dis. Clin. North Am.2017 Jun;31(2):325-338.
2. BadylakSF, FreytesDO, Gilbert TW. Extracellular matrix as a biological scaffold material: Structure and function. ActaBiomater. 2009;5:1-13.
3. DorweilerB, Trinh TT, et al. The marine Omega3 wound matrix for treatment of complicated wounds. Gefasschirurgie.2018; 23:S46-S55