The use of fragmented intact fish skin in patients with moderate to severe hidradenitis suppurativa for definitive lesion closure

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that significantly affects the skin areas where apocrine glands are found. Severe forms of the disease may require extensive surgical resection and reconstruction. A hallmark of fragmented intact fish skin grafts (FSG) is their ability to enhance the granulation response and thus give the “from the bottom” healing so desirable in these circumstances. FSG can potentially be used to fill lesions of HS patients after conservative deroofing procedures.

Methods: In this clinical case study, we present five patients with (HS) ranging from moderate to severe with a total of seven operated wounds. Three of the patients are on adalimumab (biologics treatment). The operation chosen was deroofing the lesions and debridement of scar tissue to ensure a healthy wound bed. All scar tissue was not necessarily excised. The fragmented FSG was prepared based on the manufacturer’s instructions. Only simple secondary dressings were needed to secure the graft.

Results: Satisfactory results for wound healing were achieved with the fragmented intact FSG. This variant of FSG allows for more straightforward application into deep, irregularly shaped wounds than intact FSG in sheet form. With the fragmented intact FSG, epithelialization was seen as early as 14 days. Wound closure on average was achieved by 21 days post-application when compared with our standard of care for these types of lesions, where wound closure would require at least one month or more. No seromas or premature closures of the skin over the tissue defects were observed.

Discussion: HS in its severe form is a debilitating disease. Notwithstanding the use of powerful drugs such as biologics, operations on large lesions must be performed in a timely fashion to avoid hopeless chronicity. However, these operations always leave a cavity. The use of fragmented FSGs has shown promise in treating lesions related to these operations and warrants further investigations as a skin substitute in post-excisional dermatological wounds.