(CS-120) Novel Application of Fish Skin Grafts in Pilonidal Wounds

Introduction:

Pilonidal excision is a surgical procedure to treat a pilonidal cyst or sinus. Several forms of wound closure can be used for pilonidal wounds, and the choice of closure technique may depend on various factors. Wound complication rates and infections are expected in these patients ranging from 10% to 30% (Mahmood et al., 2020)¹. Kerecis is a fish skin-derived acellular dermal matrix product used in various wound care applications (Lantis et al., 2023; Badois et al., 2019) ^2,3. While it has shown promising results in wound healing, it is essential to note that its use specifically for wound closure in pilonidal disease has yet to be widely established. Our Case series studies three patients who received Kerecis fish skin graft to assist with granulation tissue and primary colure without complications.

Methods:

We selected three random patients with recurrent pilonidal disease who underwent primary excision and closure in their operation. They were all healthy adults of ages 16, 23, and 26. The patients had primary excision, and the wound was irrigated and washed with peroxide, followed by applying Kerecis fragmented xenograft. We made sure there was adequate bleeding at the wound base as well. After this, two wounds were closed with Karydakis flaps and one with a Y-advancement flap, as it required extensive debridement. The skin was closed with mattress nylon sutures. All patients went home with post-op dressings, including bacitracin ointment once a day and instructions to keep pressure off the incision. They were all followed on post-op day 21 for removal of sutures and wound check-ups.

Results:

All the patients followed up on time. None of them had any wound complications, including wound breakdown or infection. The sutures were removed, and they returned to normal activities without restrictions.

Discussion:

Fish skin xenografts are FDA approved for treating chronic and acute surgical wounds^4,5. The product is an acellular dermal matrix harvested from Icelandic cod with a porous microstructure like human skin. Characteristics of xenograft include bacterial resistance, angiogenesis, and inflammatory cytokine mitigation⁶. Our study noted no wound complications and excellent wound healing after one application of the Kerecis product. These wounds included complex wounds with advancement flaps and obese patients. The study's infancy requires more cases to prove a stronger correlation. It is an encouraging start with a cautiously optimistic hope to become the standard of care for pilonidal wounds.

Trademarked Items:

References: 1.Mahmood, F., Hussain, A., & Akingboye, A. (2020). Pilonidal sinus disease: review of current practice and prospects for endoscopic treatment. Annals of medicine and surgery, 57, 212-217.
2.Lantis Ii, J. C., Lullove, E. J., Liden, B., McEneaney, P., Raphael, A., Klein, R., Winters, C., & Huynh, R. N. (2023). Final efficacy and cost analysis of a fish skin graft vs standard of care in the management of chronic diabetic foot ulcers: a prospective, multicenter, randomized controlled clinical trial. Wounds: a compendium of clinical research and practice, 35(4), 71–79. https://doi.org/10.25270/wnds/22094
3.Badois, N., Bauër, P., Cheron, M., Hoffmann, C., Nicodeme, M., Choussy, O., ... & Fromantin, I. (2019). Acellular fish skin matrix on thin-skin graft donor sites: a preliminary study. Journal of Wound Care, 28(9), 624-628.
4.Baldursson BT, Kjartansson H, Konrádsdóttir F, Gudnason P, Sigurjonsson GF, Lund SH. Healing rate and autoimmune safety of full-thickness wounds treated with fish skin acellular dermal matrix versus porcine small-intestine submucosa: a noninferiority study. Int J Low Extrem Wounds. 2015 Mar;14(1):37-43. doi: 10.1177/1534734615573661. Epub 2015 Mar 9. PMID: 25759413.
5.Lullove, E. J., Liden, B., Winters, C., McEneaney, P., Raphael, A., & JC, L. I. (2021). A Multicenter, Blinded, Randomized Controlled Clinical Trial Evaluating the Effect of Omega-3-Rich Fish Skin in the Treatment of Chronic, Nonresponsive Diabetic Foot Ulcers. Wounds: a Compendium of Clinical Research and Practice.
6.Magnusson S, Baldursson BT, Kjartansson H, Rolfsson O, Sigurjonsson GF. Regenerative and Antibacterial Properties of Acellular Fish Skin Grafts and Human Amnion/Chorion Membrane: Implications for Tissue Preservation in Combat Casualty Care. Mil Med. 2017 Mar;182(S1):383-388. doi: 10.7205/MILMED-D-16-00142. PMID: 28291503.