The Use of Acellular Fish Skin Graft for Surgical Wounds following Multifocal Deep Tissue Infection

Staphylococcal scalded skin syndrome (SSSS) is a disorder that develops because of a toxin produced by a staph infection which spreads from the bloodstream to the skin and specifically binds to a target protein high in the epidermis producing blistering and sloughing of the skin [1]. Immunocompromised adults or patients with insufficient kidney function are susceptible. Extensive soft tissue damage can result leading to large wounds with unhealthy surrounding skin making traditional wound care treatments difficult and painful.

A 66-year-old male with no significant past medical history was admitted for increasingly edematous and erythematous lower extremity with large areas of bullae 1 week after sustaining puncture wound on medial foot from a piece of metal while at work. Patient also presented with lactic acidosis and acute kidney injury. IV antibiotics were administered, and MRI obtained demonstrated a small subcutaneous fluid collection to the anterior lower leg. A bedside I&D was performed and then the patient was discharged home to follow up at wound care center with continued antibiotics. Patient was admitted a week later for increasing fluctuance, pain and blistering along the lower leg and diagnosed with SSSS. Subsequent MRI demonstrated large fluid collections along tendon and fascial planes from lateral foot to anterior lower leg. Patient underwent additional I&D to the foot and lower leg as well as anteromedial and anterolateral leg fasciotomies with application of antibiotic beads. Patient underwent removal of antibiotic beads and additional wound debridement 4 days later with application of wound vac. One week later, patient had an acellular fish skin wound matrix* placed with re-application of the wound vac. Patient underwent 2 additional applications of fish skin matrix at weeks 2 and 4 from initial application. Complete epithelialization of the wounds with minimal scar contracture was noted 8 weeks following first application. There was no recurrence of infection.

This case demonstrates the use of an acellular fish skin matrix* for use in the healing of deep surgical wounds status post fasciotomies secondary to multi-focal tissue infection.

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References (if applicable): 1. Cohen BA. Staphylococcal Scalded Skin Syndrome. National Organization of Rare Disorders. 2018