(CS-149) Application of Fish Skin Grafts to Facilitate Healing of A Dysvascular Diabetic Ulcer of the Hand: A Case Study
Andrew Blint, MD; George Lester, FNP-BC, RNFA
Introduction: Patient is a 49-year-old male with a history of type 1 diabetes. He has a history of a below-knee amputation on the left and a transmetatarsal amputation of the right foot. Patient was initially consulted for the ulcer to the anterior aspect of the tibial tuberosity of each lower leg. These had developed as the patient found it necessary to crawl to get into the bathroom due to his living quarters.
Methods: The patient presented to the hospital on April 19, 2023 for cellulitis of the right hand. He had burned the hand with hot water several weeks earlier. Subsequent developed infection to the right hand primarily affecting the lateral aspect including the 5th finger. Multiple attempts were made to transfer the patient to a center with either hand specialist or vascular surgeon as the ulnar artery was difficult to palpate and subsequently determined to be occluded via arterial duplex studies. When transferring was unsuccessful patient was admitted for IV antibiotic therapy, wound management and evaluation. Consultation was directed to the Wound Care Center for recommendations for the 5th finger and lateral aspect of the hand. Initial evaluation revealed that the 5th finger was ischemic with early gangrenous changes. The orthopedist was consulted at this time after cultures revealed Proteus mirabilis and methicillin-resistant Staph aureus.
Patient subsequently underwent amputation of the 5th finger, right hand on April 26, 2023. treatment at that time also included partial resection of the 5th metacarpal. Vera flow therapy was then initiated with gentamicin and saline solution mixture for irrigation of the wound. Necrotic tissue persisted to the wound with exposed 5th metacarpal. Patient was brought back to the OR and additional bone of the 5th metacarpal was resected. Treatment at that time also included application of MicroGraft (Kerecis Fish Skin) grafting and Surgimend. Wound VAC therapy was performed following surgery. Additional micronized graft and Surgimend was applied 2 weeks later.
Results: The patient was seen by the orthopedic hand specialist when the patient was admitted for cellulitis of the 4th finger. Fourth finger did require amputation. The initial ulcer to the lateral aspect of the hand resolved utilizing combination of fish skin grafting, VeraFlow and wound VAC.
Discussion: This case represents the ability of a less than optimal wound environment to heal utilizing fish skin grafting when combined with proper debridement and vacuum assisted closure therapy.
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