(CS-003) The use of fragmented intact fish skin graft* in lower leg surgical wounds for definitive lesion closure
Co-Author(s):
Ryan O'Quinn, MD
<b>Introduction</b>: <span style="font-size: 12.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Lower leg surgical wounds post excisional removal of cancer lesions are challenging to heal many patients due to proximity and underlying medical conditions such as diabetes mellitus and peripheral vascular disease. Patients may require long term wound management or hyperbaric oxygen therapy to achieve favorable outcomes. <em>A hallmark of fragmented intact fish skin grafts (FSG) is their ability to fill up irregular tissue defects after surgical procedures or trauma.</em> Without the risk of viral disease transfer from fish to human, the FSG is gently processed maintaining the natural three-dimensional structure as well as the chemical complexity that are homologous to human skin.<span style="mso-spacerun: yes;"> </span>FSG can effectively be used to heal lower extremity wounds post-surgical excision. </span><br/><br/><b>Methods</b>: <span style="font-size: 12.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">In this clinical case study, three patients presented with one or more underlying medical conditions that included poorly controlled diabetes mellitus, venous stasis, arterial and venous insufficiency, and hypertension. All patients had surgical management of skin cancer to the lower extremity requiring closure. The treatment option chosen was skin substitute grafting using FSG. The FSG was prepared based on the manufacturer's instructions. Simple secondary dressings were used to secure the graft with negative pressure wound vac when appropriate. </span><br/><br/><b>Results</b>: <p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">Complete wound healing was achieved in all three patients. The use of fragmented intact FSG promoted healthy granulation tissue formation despite underlying medical conditions. Similar porosity to that of human skin, allows for rapid fibroblast cell recognition, migration, and proliferation into the FSG. Patient with uncontrolled diabetes mellitus healed in five months with three applications of FSG. Patient with hypertension and peripheral vascular disease healed in four months with four applications of FSG. Patient with extensive venous and arterial vascular insufficiency healed in seven months with ten applications of FSG.</span></p><br/><br/><b>Discussion</b>: <p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">Lower extremity wounds are challenging to heal. Underlying medical conditions increase the risk of limb loss due to wound closure failure. The use of fragmented FSGs has shown to promote wound healing in these challenging environments and warrants further investigations as a skin substitute in post-excisional dermatologic wounds. </span></p><br/><br/><b>Trademarked Items</b>: *KerecisTM, Kerecis, Isafjordur, Iceland<br/><br/><b>References</b>: <br/><br/>