(CS-112) Use of Fish Skin Graft to Heal Wounds with Exposed Bone

Healing wounds with exposed bone can be particularly challenging. Unlike soft tissues, bone has limited capacity for spontaneous regeneration and repair (1). Additionally, the presence of exposed bone exposes the wound to increased risk of infection, as bone is more susceptible to bacterial colonization than intact soft tissues. Moreover, the lack of a protective barrier, such as skin or muscle, impedes the formation of granulation tissue, which is crucial for wound healing (2). 

Fish skin graft (FSG)* offers unique advantages in healing wounds over exposed bone. FSG contains intact fish skin collagen, which provides a framework for cell migration, proliferation, and tissue regeneration (3). The collagen in the FSG stimulates the production of growth factors and cytokines, promoting wound healing (4). Moreover, FSG possesses a natural three-dimensional structure that aids in the formation of granulation tissue and neovascularization (3). FSG also reduces the risk of infection by acting as a barrier and preventing bacterial colonization on the exposed bone surface (4). The purpose of this study is to show proof of the ability of FSG to heal over bone.

Methods: Patient with a severe case of 1st MPJ acute gout had an incision and drainage where all the gouty tophi was debrided and removed. The gouty tophi were embedded in the tendons, capsule and all the periarticular soft tissue, which after debridement resulted in a large medial wound with exposed first metatarsal head and no periarticular soft tissue. FSG was applied into the graft and at subsequent office visits it was re-applied as needed.

Results: Two weeks after first application of FSG, significant granulation tissue was noted covering the entire bone. After subsequent debridements and applications over the next few months, the wound was completely healed.

Discussion: As evidenced, the unique properties of FSG make it an effective option for promoting healing over bone. Further applications of the graft in this manner are warranted to solidify it as a viable treatment modality to heal wounds with exposed bone.

Trademarked Items:

References: 1. Marsell, R., & Einhorn, T. A. (2011). The biology of fracture healing. Injury, 42(6), 551-555.

2. Wu, S. C., Marston, W., Armstrong, D. G., & Wrobel, J. S. (2015). Soft tissue and wound healing in diabetes. Medical Clinics, 99(1), 113-129.

3.Gudmundsson, S., Carcamo, M., & Gudbjartsson, T. (2016). New technology for management of chronic wounds in difficult anatomical areas using fish skin graft. International Wound Journal, 13(6), 1257-1263.

4. Carcamo, M., Olafsdottir, B. J., Martinsen, Ø. G., Martens, H., & Gudmundsson, S. (2019). Wound Healing and Antibacterial Activity of a Novel Fish Skin Graft. Marine Drugs, 17(7), 418.