Innovative Acellular Fish-Skin Graft for Healing of a Second Ray Amputation Site: A Case Study

Introduction: Ray amputations can be challenging to heal. Failure to heal these types of amputations can result in poor patient outcomes. We present a case in which a diabetic female was admitted to the wound care center with a large wound status-post second ray amputation. She was treated with applications of an acellular fish skin graft to facilitate wound healing.

Methods: This patient was a 61-year-old female with NIDDM who presented to the wound center for treatment of a diabetic foot ulcer (DFU) on the distal aspect of her second toe. At an outside facility, the patient underwent a 2nd ray amputation and followed-up at the aforementioned wound center. Upon initial presentation, her surgical wound measured 14cm L x 1.5cm W x 0.7cm D with antibiotic beads and sutures in place. The sutures and antibiotic beads were then removed for better visualization of the wound, creating a large soft tissue deficit spanning from the dorsal to plantar aspect of the foot. The patient was initially treated for 5 weeks with an enzymatic debrider, as well as weekly sharp debridements to remove any remaining biofilm/slough. The acellular fish skin graft was subsequently applied on a bi-weekly basis.

Results: Each application of the fish skin graft resulted in significant improvement of the wound. After a total of 10 graft applications, complete wound closure and epithelialization was achieved.

Discussion: In this case, we present a complicated surgical wound in which application of a fish skin graft was used to achieve complete wound healing. This graft, which contains omega-3 fatty acids, accelerated wound conversion from the inflammatory phase to the proliferative phase and subsequent epithelialization. We believe that this particular patient and case study provide substantial evidence for favorable wound healing when utilizing a fish skin graft, and believe it to be an excellent alternative for healing complicated surgical wounds.