Clinical Experience of Omega 3 Fish Graft in Full Thickness Wounds

Editorial Summary

This article is an overview of a case series which examines how decellularized intact fish skin grafts facilitate the healing process in full thickness burn injuries, and describes over time its integration into the wound during follow up after application. Historically, options for reconstruction include various xenografts as well as allografts. Omega3 fatty acids (EPA and DHA) are known for their anti-inflammatory properties. Fish skin grafts have been well established in the management of other challenging clinical scenarios.1-5

Introduction

Current treatments of partial and full thickness burns include various xeno and allografts. Allografts (cadaveric skin) will need to be removed and mammalian derived acellular grafts need harsh processing to decrease the risk of viral disease transmission. Recent advances in technology have made it possible to process fish sourced tissue with a more gentle process, making it safe for medical applications while preserving its intrinsic structure and biological benefits.

Previously published clinical trials showed that full-thickness acute wounds treated with fish skin grafts (FSGs) healed significantly faster than wounds treated with porcine tissue.6-8

Methods

In this case series, three burn patients aged 2271 of various ethnicities, with burn wound sizes ranging from 3-19% Total Body Surface Area (TBSA), received FSGs (Omega3 GraftGuide, Kerecis, Ísafjörður, Iceland (Figure 1)) applied post debridement and/ or excision. The fish skin graft effects on wound healing were evaluated regarding time to wound closure, restoration of barrier function, and complications; level of pain was recorded.

Patient 1: 22 year old male, thermal burn to the back.

The patient, with a past medical history of hydronephrosis, presented with a 19% TBSA thermal burn.

The mechanism of the burn was bonfire-induced, with clothing set alight. The patient presented to the burn center two days post initial injury having had an initial treatment with silver sulfadiazine cream. A single application of fish skin graft resulted in good secondary intention healing for the patient, without the need for an autograft.

2a, 2b: Initial presentation images .

2c: Day 2 pre-treatment images.

2d, 2e: Day 2 post dermabrasion and fish skin graft application.

2f: Post-operative day 4.

2g, 2h: Post-operative day 15.

2i: Post-operative day 21.

Patient 2: 71 year old male, thermal burn to the right arm.

The patient, with a past medical history of hypertension and hyperlipidemia, presented with a 17% TBSA thermal burn due to a lawn tractor.

The patient presented on day 4 post injury after sustaining an explosion after hitting a gas line.

At the 1 year follow up visit, skin matching is significantly improved; the skin quality is soft, flat and pliable, with minimum itching. There was excellent range of movement with no limitation.

3a, 3b: Initial presentation 4 days post burn injury, prior to fish skin graft application.

3c, 3d: Post-operative day 3.

3e, 3f: Post-operative day 10.

3g, 3h: Post-operative day 60.

3i, 3j: Follow up, 9 months; no itching or pain, flat with small areas of hypertrophy.