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Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series

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Methods: Ten patients having split-thickness skin grafting for burn injury were treated with the fish skin xenografts. Results: There were no adverse reactions noted on the use of the fish skin grafts. No patient had any reaction to the fish skin and there was a zero incidence of infection. The handling of the fish skin was excellent, a robust and pliable xenograft that was easy to apply.The quality of donor site healing was judged to be good in all cases. Both the analgesic effect noted and the relatively short average times until 100% re-epithelialization are promising. We also illustrate two cases where the dressing was used to treat superficial burns.
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MILITARY MEDICINE, 184, 3/4:16, 2019
Acellular Fish Skin Grafts for Management of Split Thickness
Donor Sites and Partial Thickness Burns: A Case Series
Khurshid Alam*; Lt Col Steven LA Jeffery, RAMC†‡
ABSTRACT When treating large burns, autologous skin availability becomes a problem and burn surgeons rely heavily
on allogenic and xenogeneic skin for temporary coverage after excision. Application of cadaveric and pig skin grafts carries
a risk of auto-immune response and risk of viral and bacterial diseases transmission, and there are many cultural and reli-
gious rejections for use of porcine grafts. There has recently become available an alternative resource of xenograft using
acellular sh skin (KerecisTM Omega3 Burn). This has been described as providing an effective, safe, efcient skin substi-
tute, free of the risk of transmission of viral disease, and auto-immune reaction risk. Methods: Ten patients having split-
thickness skin grafting for burn injury were treated with the sh skin xenografts. Results: There were no adverse reactions
noted on the use of the sh skin grafts. No patient had any reaction to the sh skin and there was a zero incidence of infec-
tion. The handling of the sh skin was excellent, a robust and pliable xenograft that was easy to apply. The quality of donor
site healing was judged to be good in all cases. Both the analgesic effect noted and the relatively short average times until
100% re-epithelialization are promising. We also illustrate two cases where the dressing was used to treat supercial burns.
INTRODUCTION
Early excision and application of Split Skin Grafting is the
main stay of treatment of deep dermal and full thickness burn
injury to avoid common complications like sepsis, multi-organ
failure, and acute kidney injury.
1
When treating large burns,
autologous skin availability becomes a problem and burn sur-
geons often rely heavily on allogenic and xenogeneic skin for
temporary coverage after excision. Human cadaver and pig
skin are major sources of this temporary coverage. Application
of cadaveric and pig skin grafts carries a risk of auto-immune
response and risk of viral and bacterial diseases transmission,
2
and there are many cultural and religious rejections for use of
porcine grafts in many Muslim countries.
3
Cadaveric skin is in
limited supply and is understandably very expensive.
There has recently become available an alternative resource
of xenograft using acellular sh skin (Kerecis Omega3 Burn).
This has been described as providing an effective, safe, efcient
skin substitute, free of the risk of transmission of viral disease,
4
and auto-immune reaction risk.
3,5
Furthermore, acellular sh
skin has also been used with signicant success in the healing
process of acute
6
and hard to heal wounds like diabetic foot
ulcer, and chronic non-healing leg wounds of other varieties.
3
Despite being separated by over 350 million years of evo-
lution, sh skin has great similarity to mammalian skin due
to its conserved protein structure.
7
The skin of cold-sea
adapted species like the Atlantic cod is, however, far richer
in omega-3 polyunsaturated fatty acids (PUFAs) than warm-
sea adapted species. It has a porous microstructure
8,9
and has
been described as being useful to cover exposed tendon and
bone,
10,11
initiating granulation of the exposed wound bed to
kickstart a stagnated healing process.
The minimal processing required in the manufacturing of
sh skin maintains its three-dimensional structure, as well as its
anti-inammatory and anti-infective properties. Fish species
indeed live in an aquatic environment substantially richer in
pathogens compared to the aerial environment of humans.
12
Fish skin is rich in Omega3 PUFAs, eicosapentaenoic acid, and
docosahexaenoic acid
13
which are highly effective as antimi-
crobial agents and in modulating the inammatory response of
the acute wound healing stage. The sh skin is stored at room
temperature, has a shelf life of 3 years and is marketed as an
off-the-shelf product.
6
Due to these properties, sh skin is an
ideal choice for the treatment of combat casualties at Field
Hospital level, where cadaver skin or pig skin are not practical
to use due to their short shelf life and cold chain issues.
4
Due to these properties, we started using the acellular sh
skin on our burn casualties at Burn Centre of the Queen
Elizabeth Hospital Birmingham, one of the Major Burns
Centres in the UK, as a pilot to inform future randomized
controlled studies.
SPLIT THICKNESS SKIN GRAFT HARVESTING
PROCEDURE
Ten patients having split-thickness skin grafting for burn
injury were treated with the sh skin xenografts. All patients
were over 18 years of age. All donor sites were harvested at
a depth of 8/1,000th of an inch. After soaking of the sh
skin in saline, the sh skin was applied and held in place
*North Middlesex University Hospital, Sterling Way, London N18 1QX, UK.
The Royal Centre for Defence Medicine, The Queen Elizabeth
Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK.
Birmingham City University, Westbourne Road, Birmingham B15
3TN, UK.
The views expressed in this paper are those of the authors and do not
necessarily represent the ofcial position of policy of the Defence Medical
Services of the United Kingdom.
doi: 10.1093/milmed/usy280
© Association of Military Surgeons of the United States 2019. All rights
reserved. For permissions, please e-mail: journals.permissions@oup.com.
16 MILITARY MEDICINE, Vol. 184, March/April Supplement 2019
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with a secondary dressing of dry gauze. All skin graft donor
sites for each patient were thus treated. The rst dressing
change to the donor site after surgery was performed at 7
days and then was performed every 3 days thereafter until
fully healed. The symptoms and signs of infection were
assessed, and pain was assessed using a Verbal rating Score
of 010 at each dressing change. Days to 90% epithelializa-
tion and to 100% epithelialization were recorded, as assessed
visually by the senior author.
RESULTS
Ten patients were included in the donor site study. The
average age of the patients was 45 (range 1980), which
included six males and four females. The size of the donor
sites ranged from 40 cm
2
to 950 cm
2
. Time to 90% epitheli-
alization was reached with an average of 8.5 days (range
713). Time to 100% epithelialization had an average of
11.5 days (range 1016) (Fig. 1). The patient that had the
longest time until 100% re-epithelialization was the patient
with the largest surface area of donor site (950 cm
2
)and
had the most severe burn injuries.
No patients developed signs or symptoms of infection.
Pain scores averaged 2.3 (range 14) at day 7.
There were no adverse reactions noted on the use of the
sh skin grafts. No patient had any reaction to the sh skin
and there was a zero incidence of infection of the wounds.
The handling of the sh skin was excellent, a robust and pli-
able xenograft that was easy to apply.
The quality of donor site healing was judged to be good
in all cases (Fig. 2).
PARTIAL THICKNESS BURNS
We have used the sh skin as a treatment for partial thick-
ness burns in selected patients, including a cooking-oil burn to
the thigh (Fig. 3)andaame injury on a hand (Fig. 4). Neither
of these cases required skin grafting so were not included in the
donor site study. Both of the wounds were completely epithelia-
lized at the 2-week follow-up. Furthermore, the patients found
the sh skin to be comfortable and have an immediate analgesic
effect. Several patients noticed the sh smellof the product,
but no-one strongly objected to this. The end results were
esthetically pleasing, minimal scarring or color changes
(Figs 3and 4).
DISCUSSION
As this is a small case series we cannot make claims of
effectiveness, which would require a more rigorous clinical
trial. When compared to the literature it reects favorably on
the use of the sh skin graft. In the largest, multicenter ran-
domized clinical trial that has been performed on various
dressings to treat donor site wounds the median healing time
was much higher. For the hydrocolloid dressing, which out-
performed the other treatment modalities the average time to
heal was 16 days.
14
Any product that can shorten the healing
times of donor site wounds can be immensely valuable under
circumstances of a large surface area burn, necessitating fre-
quent re-harvesting of donor site areas that are very limited
in these cases.
The sh skin maintains its three-dimensional structure
and is highly porous which provide an extracellular matrix
composed of glycosaminoglycans, proteoglycans, bronectin
and growth factors
15,16
which allows the migration of autolo-
gous cells to promote the proliferative and epithelialization
phases of the burn healing process.
15,17
The graft contracts
slightly after salination and insertion in the wound bed, so it
is recommended that pre-wetting takes place before the prod-
uct is applied so that any shrinkage occurs before application
to the patient. A small area of overlap should be made, as is
normal when applying any dressing, to allow for any slight
slippage.
0
10
20
30
40
50
60
70
80
90
100
Day 7 Day 10 Day 13 Day 16
% of total patients (n = 10)
90% epithelialization 100% epithelialization
FIGURE 1. Time in days until re-epithelialization of donor site wounds.
Gray bars represent 90% and red bars complete re-epithelialization.
FIGURE 2. Left: Donor site to front of thigh. Middle: After application of sh skin. Right: Donor site fully re-epithelialized.
17MILITARY MEDICINE, Vol. 184, March/April Supplement 2019
Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns
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FIGURE 4. Healing sequence of a hand burn following ame injury. Left: After burn debridement. Middle left: Application of sh skin. Middle right:
Burn wound at 1 week, prior to reapplication of sh skin. Right: Follow-up at 2 weeks with a good healing outcome.
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
Time to Healing (Days)
FIGURE 5. Comparison of results in days until healing when using sh skin on donor site wounds in this case series with published literature.
FIGURE 3. Healing sequence of a cooking oil deep partial thickness burn to lower part of anterior thigh and knee. Left: Burn after debridement. Middle
left: 1 week after application of sh skin. Middle right: Good progression of healing at 2 weeks. Right: Three months after injury wound is healed with
excellent esthetic outcome.
18 MILITARY MEDICINE, Vol. 184, March/April Supplement 2019
Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series
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TABLE I. Literature Review on Various Healing Times of Donor Sites with Different Treatment Modalities
Type of Study Case Series RCT RCT RCT RCT RCT RCT RCT RCT RCT RCT RCT RCT
Reference Khurshid
et al
2018
Markl et al
18
Markl et al
18
Bailey et al
22
and Assadian
et al
19
Assadian
et al
19
USA
Solanki et al
20
and
Brölmann
et al
14
Kaiser et al
21
Solanki
et al
20
Brölmann
et al
14
and
Markl
et al
18
Brölmann
et al
14
Brölmann
et al
14
Brölmann
et al
14
Brölmann
et al
14
Number of
patients
10 26 20 27 17 57 15 8 74 47 45 50 49
Type Fish skin
graft
Foam
dressing
Dressing Silver dressing Dressing Dressing Gauze Dressing Silicone
dressing
Dressing Alginate
dressing
Gauze Semipermeable
lm
Brand name Kerecis
Omega3
by
Kerecis
Biatain lbu
by
Coloplast
Suprathel by
Polymedics
Aquacel Ag
Extra
Hydrober by
ConvaTec
Altrazeal by
Uluru
Duoderm by
ConvaTec
Bactigras by
Smith &
Nephew
Biobrain by
Smith &
Nephew
Mepitel by
Molnlycke
Aquacel by
ConvaTec
Kaltostat by
ConvaTec
Adaptic by
Acelity or
Jelonet by
Smith &
Nephew
Tegaderm by
3M
Time to healing
(mean number
of days)
11.5 12.8 12.9 13.0 14.2 15.2 15.4 17.0 21.0 26.0 27.1 27.9 32.9
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CONCLUSIONS
This is the rst study to show the effectiveness of using sh
skin in acute burns. The experience in our center for partial
thickness burns is promising. The healing outcomes for the
treatment of donor site wounds are also highly encouraging,
especially when compared to other RCTs on other products
(Fig. 5and Table I).
14,1822
One of the weaknesses of this study
is that this was a pilot case series with a low number of
patients. Both the analgesic effect noted and the relatively short
average times until 100% re-epithelialization are promising and
need to be studied further in a randomized controlled trial com-
paring the sh skin with current standard of care.
PRESENTATIONS
Presented as an oral presentation at the 2017 Military Health System
Research Symposium.
FUNDING
This supplement was sponsored by the Ofce of the Secretary of Defense
for Health Affairs.
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20 MILITARY MEDICINE, Vol. 184, March/April Supplement 2019
Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series
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... Burn wound healing and management as a complex and long-lasting process continues to represent a major challenge for patients and health care providers resulting in considerable socio-economic burdens [1,2]. In deep dermal and full-thickness burn injuries, early excision and application of split-thickness skin grafts is the established main treatment option to achieve early wound closure and avoid common complications such as sepsis, multi-organ failure and acute kidney injury [2,3]. However, split-thickness skin grafting may not be possible, e.g., in extended burns with limited donor skin availability [4]. ...
... As suggested in prior studies, wound healing acceleration might be caused due to an increased cell proliferation and a synergistic effect of the biophysical properties of AFS [31]. In a different case series by Alam et al., wound healing of split-thickness donor sites treated with Kerecis ® Omega3 showed an average total reepithelialization time of 11.5 days (range 10-16 days) [3], whereby longer reepithelialization time is observed in larger donor sites or thicker split-thickness grafts [30]. ...
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... However, the coverage of extensive full-thickness wounds can be limited by autografting alone. Burn surgeons rely heavily on allogenic and xenogeneic skin for temporary application after excision for various reasons [2]. These materials reduce evaporative water loss and the exudation of protein-rich fluids, prevent wound desiccation, and suppress microbial proliferation. ...
... Also, various research papers on chronic wounds and on burns have only reported a few clinical case reports on the treatment effect analysis using a pig animal model and donor sites for burn patients. In other word, there is no existing paper comparing the therapeutic effect of fish collagen with pig or bovine collagen [2,7,8]. ...
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... This momentary coverage is primarily derived from human cadavers and pig skin 2 . Using such cadaveric and pig skin grafts involves the risk of an autoimmune response as well as the transmission of bacterial and/or viral infections; and many cultures, such as in Muslim countries, object to using porcine grafts 2,3 . Cadaveric skin is in limited supply and thus incredibly costly 3 . ...
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Burns disrupt the protective skin barrier with consequent loss of cutaneous temperature regulation, infection prevention, evaporative losses, and other vital functions. Chronically, burns lead to scarring, contractures, pain, and impaired psychosocial well-being. Several skin substitutes are available and replace the skin and partially restore functional outcomes and improve cosmesis. We performed a literature review to update readers on biologic and synthetic skin substitutes to date applied in acute and reconstructive burn surgery. Improvement has been rapid in the development of skin substitutes in the last decade; however, no available skin substitute fulfills criteria as a perfect replacement for damaged skin.
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Background: The optimal therapy for deep burn wounds is based on the early debridement of necrotic tissue followed by wound coverage to avoid a systemic inflammatory response and optimize scar-free healing. The outcomes are affected by available resources and underlying patient factors, which represent challenges in burn care and suboptimal outcomes. In this study, we aimed to determine optimal burn-wound management using enzymatic debridement (NexoBrid™, MediWound Germany GmbH, Rüsselsheim, Germany) and intact fish skin (Kerecis® Omega3 Wound, Isafjordur, Iceland). Methods: In this retrospective case series, 12 patients with superficial or deep dermal burn wounds were treated with enzymatic debridement followed by fish skin, Suprathel® (PolyMedics Innovations GmbH, Denkendorf, Germany), or a split-thickness skin graft (STSG). Patients’ outcomes regarding healing and scar quality were collected objectively and subjectively for 12 months after the burn injury. Results: Wounds treated with fish skin demonstrated accelerated wound healing, a significantly higher water-storage capacity, and better pain relief. Furthermore, improved functional and cosmetic outcomes, such as elasticity, skin thickness, and pigmentation, were demonstrated. The pain and itch expressed as POSAS scores (Patient and Observer Scar Assessment Scale) for fish skin decreased compared to those for wounds managed with an STSG or Suprathel. Importantly, fish skin-treated wounds had significantly improved sebum production and skin elasticity than those treated with Suprathel but showed no significant superiority compared to STSG-treated wounds. Conclusions: Enzymatic debridement in combination with intact fish skin grafts resulted in the faster healing of burn wounds and better functional and aesthetic outcomes than split-thickness skin grafts and Suprathel treatment.
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Background: Improvised explosive devices and new directed energy weapons are changing warfare injuries from penetrating wounds to large surface area thermal and blast injuries. Acellular fish skin is used for tissue repair and during manufacturing subjected to gentle processing compared to biologic materials derived from mammals. This is due to the absence of viral and prion disease transmission risk, preserving natural structure and composition of the fish skin graft. Objectives: The aim of this study was to assess properties of acellular fish skin relevant for severe battlefield injuries and to compare those properties with those of dehydrated human amnion/chorion membrane. Methods: We evaluated cell ingrowth capabilities of the biological materials with microscopy techniques. Bacterial barrier properties were tested with a 2-chamber model. Results: The microstructure of the acellular fish skin is highly porous, whereas the microstructure of dehydrated human amnion/chorion membrane is mostly nonporous. The fish skin grafts show superior ability to support 3-dimensional ingrowth of cells compared to dehydrated human amnion/chorion membrane (p < 0.0001) and the fish skin is a bacterial barrier for 24 to 48 hours. Conclusion: The unique biomechanical properties of the acellular fish skin graft make it ideal to be used as a conformal cover for severe trauma and burn wounds in the battlefield.
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Re-epithelialization of cutaneous wounds in adult mammals takes days to complete and relies on numerous signalling cues and multiple overlapping cellular processes that take place both within the epidermis and in other participating tissues. Re-epithelialization of partial- or full-thickness skin wounds of adult zebrafish, however, is extremely rapid and largely independent of the other processes of wound healing. Live imaging after treatment with transgene-encoded or chemical inhibitors reveals that re-epithelializing keratinocytes repopulate wounds by TGFβ- and integrin-dependent lamellipodial crawling at the leading edges of the epidermal tongue. In addition, re-epithelialization requires long-range Rho kinase-, JNK- and, to some extent, planar cell polarity-dependent epithelial rearrangements within the following epidermis, involving radial intercalations, flattening and directed elongations of cells. These rearrangements lead to a massive recruitment of keratinocytes from the adjacent epidermis and make re-epithelialization independent of keratinocyte proliferation and the mitogenic effect of FGF signalling, which are only required after wound closure, allowing the epidermis outside the wound to re-establish its normal thickness. Together these results demonstrate that the adult zebrafish is a valuable in-vivo model for studying, and visualizing, the processes involved in cutaneous wound closure, facilitating the dissection of direct from indirect, and motogenic from mitogenic effects of genes and molecules affecting wound re-epithelialization.
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Introduction: Acellular fish skin of the Atlantic cod (Gadus morhua) is being used to treat chronic wounds. The prevalence of diabetes and the comorbidity of chronic wounds is increasing globally. The aim of the study was to assess the biocompatibility and biological characteristics of acellular fish skin, important for tissue repair. Materials and methods: The structure of the acellular fish skin was examined with microscopy. Biocompatibility of the graft was conducted by a specialized certified laboratory. Protein extracts from the material were analyzed using gel electrophoresis. Cytokine levels were measured with an enzyme linked immunosorbent assay (ELISA). Angiogenic properties were assessed with a chick chorioallantoic membrane (chick CAM) assay. Results: The structure of acellular fish skin is porous and the material is biocompatible. Electrophoresis revealed proteins around the size 115-130 kDa, indicative of collagens. The material did not have significant effect on IL-10, IL-12p40, IL-6 or TNF-α secretion from monocytes or macrophages. Acellular fish skin has significant effect on angiogenesis in the chick CAM assay. Conclusion: The acellular fish skin is not toxic and is not likely to promote inflammatory responses. The graft contains collagen I, promotes angiogenesis and supports cellular ingrowth. Compared to similar products made from mammalian sources, acellular fish skin does not confer a disease risk and contains more bioactive compounds, due to less severe processing. Key words: Fish skin, extracellular matrix, acellular dermal graft, wound healing, tissue repair. Correspondence: Baldur Tumi Baldursson, btb@kerecis.com.
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Advances in our understanding of the mechanisms that bring about the resolution of acute inflammation have uncovered a new genus of pro-resolving lipid mediators that include the lipoxin, resolvin, protectin and maresin families, collectively called specialized pro-resolving mediators. Synthetic versions of these mediators have potent bioactions when administered in vivo. In animal experiments, the mediators evoke anti-inflammatory and novel pro-resolving mechanisms, and enhance microbial clearance. Although they have been identified in inflammation resolution, specialized pro-resolving mediators are conserved structures that also function in host defence, pain, organ protection and tissue remodelling. This Review covers the mechanisms of specialized pro-resolving mediators and omega-3 essential fatty acid pathways that could help us to understand their physiological functions.
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Introductions The Kerecis™ Omega3 Wound matrix is a decellularized skin matrix derived from fish skin and represents an innovative concept to achieve wound healing. The aim of this study was to report the cumulative experience of three centers for vascular surgery regarding use of the Omega3 Wound matrix in selected patients with complicated wounds. Material and methods In this study 23 patients with 25 vascular and/or diabetes mellitus-associated complicated wounds and partially exposed bony segments were treated with the Omega3 Wound matrix in three vascular centers. In several patients conventional wound treatment with vacuum therapy had previously been carried out sometimes over several weeks without durable success. Following initial debridement in the operating room, the matrix was applied and covered with a silicone mesh. In the further course, wound treatment was conducted on an outpatient setting if possible. Results In total 25 wounds were treated with localization at the level of the thigh (n = 2), the distal calf (n = 7), the forefoot (n = 14) and the hand (n = 2). The time to heal varied between 9 and 41 weeks and between 3 and 26 wound matrices were applied per wound. Interestingly, a reduction of analgetics intake was noted when the treatment with the Omega3 Wound matrix was initiated. Conclusions The novel Omega3 Wound matrix in this study represented an effective treatment option in 25 complicated wounds. Further studies are necessary to evaluate the impact of the wound matrix on stimulation of granulation tissue and re-epithelialization as well as the potential antinociceptive and analgetic effects.
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Introduction: A novel piscine acellular fish-skin graft product has 510k clearance on the US market. This product (Omega3, Kerecis, Isafjordur, Iceland) is to be used similarly to extracellular matrices (ECMs) on the market (eg, bovine and porcine) except that it contains fats, including omega-3 polyunsaturated fatty acids that have been associated with anti-inflammatory properties in many studies. While many current ECMs are effective on open wounds, studies have largely excluded application to hard-to-heal ulcers. To test this product in a real-world environment, the authors chose to look specifically at hard-to-heal ulcers based on previously defined wound and patient factors. Methods: The primary objective was to assess the percentage of wound closure area from baseline after 5 weekly fish-skin graft applications in 18 patients with at least 1 "hard-to-heal" criteria. Patients underwent application of the fish skin for 5 sequential weeks, followed by 3 weeks of standard of care. Wound area, skin assessments, and pain were assessed weekly. Results: A 40% decrease in wound surface area (P < 0.05) and a 48% decrease in wound depth was seen with 5 weekly applications of the fish-skin graft and secondary dressing (P < 0.05). Complete closure was seen in 3 of 18 patients by the end of the study phase. Conclusion: This fish-skin product appears to provide promise as an effective wound closing adjunctive ECM. This is true when used in this compassionate setting, where many other products fail. This study lacks a control arm and an aggressive application schedule, but the investigators believe it represents real-world practice.
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Introduction: Complicated wounds in the lower extremity can arise as a consequence of insufficient soft-tissue coverage after amputations in diabetic patients. The Kerecis® Omega3 wound matrix is a decellularized skin matrix derived from codfish and represents an alternative treatment option to achieve wound healing. Methods: 5 patients with diabetes mellitus and complicated wounds in the lower limb with exposed bony segments were treated with the Omega3 wound matrix between November 2014 and November 2015. Following initial debridement in the operating room, the wound matrix was applied and covered with a silicone mesh. In the further course, wound treatment was conducted on outpatient setting. Results: In total, 7 wounds were treated with localization at the level of the thigh (n=2) and the forefoot (n=5). For the wounds at the thigh, it took 26 weeks to achieve wound closure, whereas the wounds at the level of the forefoot showed healing times between 13 and 41 weeks. In all patients, a reduction of analgetics intake was noted when the treatment with the Omega3 wound matrix was initiated. Conclusion: The Kerecis® Omega3 wound matrix represents a viable treatment option in complicated wounds in the lower limb of diabetic patients to circumvent an otherwise necessary proximalization of amputation level. Further studies comparing the Omega3 wound matrix with appropriate control groups of standard therapies for soft-tissue conditioning/coverage like negative pressure therapy, biosurgery and other acellular dermal matrices are warranted.
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A novel product, the fish skin acellular dermal matrix (ADM) has recently been introduced into the family of biological materials for the treatment of wounds. Hitherto, these products have been produced from the organs of livestock. A noninferiority test was used to compare the effect of fish skin ADM against porcine small-intestine submucosa extracellular matrix in the healing of 162 full-thickness 4-mm wounds on the forearm of 81 volunteers. The fish skin product was noninferior at the primary end point, healing at 28 days. Furthermore, the wounds treated with fish skin acellular matrix healed significantly faster. These results might give the fish skin ADM an advantage because of its environmental neutrality when compared with livestock-derived products. The study results on these acute full-thickness wounds might apply for diabetic foot ulcers and other chronic full-thickness wounds, and the shorter healing time for the fish skin-treated group could influence treatment decisions. To test the autoimmune reactivity of the fish skin, the participants were tested with the following ELISA (enzyme-linked immunosorbent assay) tests: RF, ANA, ENA, anti ds-DNA, ANCA, anti-CCP, and anticollagen I and II. These showed no reactivity. The results demonstrate the claims of safety and efficacy of fish skin ADM for wound care. © The Author(s) 2015.
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This prospective, randomised study compares a new transforming methacrylate dressing (TMD) with a silver-containing carboxymethylcellulose dressing (CMC-Ag) after application to split-thickness skin graft (STSG) donor sites. This was an unblinded, non-inferiority, between-patient, comparison study that involved patients admitted to a single-centre burn unit who required two skin graft donor sites. Each patient's donor sites were covered immediately after surgery: one donor site with TMD and the other with CMC-Ag. The donor sites were evaluated until healing or until 24 days post-application, whichever came first. Study endpoints were time to healing, daily pain scores, number of dressing changes, patient comfort and physicians' and patients' willingness to use the dressings in the future. Nineteen patients had both the dressings applied. No statistically significant difference was noted in time to healing between the two dressings (14·2 days using TMD compared with 13·2 days using CMC-Ag). When pain scores were compared, TMD resulted in statistically significantly less pain at three different time periods (2-5 days, 6-10 days and 11-15 days; P < 0·001 at all time periods). Patients also reported greater comfort with TMD (P < 0·001). Users rated TMD as being less easy to use because of the time and technique required for application. Reductions in pain and increased patient comfort with the use of the TMD dressing, compared with CMC-Ag, were seen as clinical benefits as these are the major issues in donor site management.