Use of Intact Fish Skin Graft with Omega-3 on Atypical, Difficult-to-Heal Wounds

The aim was to evaluate the benefits of an acellular fish skin to treat wounds with exposed bone. The intent was to promote granulation over bone to allow full epithelialization of the wound bed. Acellular fish skin retains soluble molecules and fatty acids through its processing cycle, retaining the natural porosity and micromolecule environment of the skin, favorable for cell ingrowth and wound healing. Three cases are described. Two cases involved Mohs procedure to the scalp. The third case was a gangrenous thumb requiring debridement of bone in the operating room. All patients had multiple, severe comorbidities. In all cases, the wounds were debrided to bleeding tissue. The fish skin graft was applied over the bone and secured with sutures or adhesive strips, followed by a contact layer, wound gel, and then foam to bolster the graft.

Case 1: An 88-year-old male with history of myelodyplastic disorder, diabetes, and anemia underwent Mohs surgery of the scalp on 9/01/2017. The wound dehisced, resulting in exposed bone. Fish skin graft treatment started on 3/16/2018. Ten applications were applied within 12 weeks. On 6/20/2018, wound closed.

Case 2: A 43-year-old female with ESRD requiring hemodialysis through AV graft. Due to vascular complications of the graft, developed gangrene of the left thumb. Underwent surgical debridement, resulting in exposed bone. Fish skin graft was applied upon resolution of vascular decompensation, wound closed after three applications.

Case 3: An 83-year-old male with history of metastatic squamous cell carcinoma of the scalp, chemotherapy, and radiation. Underwent Mohs procedure on 10/12/2018, resulting in wound with exposed bone. The wound showed significant progress towards healing after nine applications of acellular fish graft over 12 weeks, healed after a total of 14 applications. Acellular fish skin facilitates granulation and tissue formation where other treatments have failed.