Use of Intact Fish Skin Graft with Omega3 on Atypical, Difficult to Heal Wounds

Purpose: 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 the bone to allow full epithelialization of the wound bed.

Methods: 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.

Case Series: Three cases are described. Two cases involving Mohs procedure to the scalp. The third case 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, then foam to bolster the graft. Patients were seen weekly.

Case 1: An 88 year old male with history of myelodysplastic disorder, diabetes and anemia underwent Mohs surgery of the scalp on 09/01/2017. The wound dehisced resulting in exposed bone. Fish skin graft treatment started 03/16/2018. Ten applications were applied within 12 weeks. On 06/20/2018, 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 3 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 bone exposed. Fish skin graft treatment was initiated on 10/31/2018, treatment is ongoing. Wound closure is anticipated by time of poster presentation. Acellular fish skin facilitates granulation and tissue formation where other treatments have failed.