Case Series/Study

(CS-023) Testing the Limits of Fish Skin Xenograft for Large Mohs Surgery Defects

Co-Author(s):

Rachel Murray, DO; Preetha Kamath, MD; Alexander Howell, DO

Introduction: Mohs micrographic surgery (MMS) is a tissue sparing technique used in the treatment of Basal cell carcinoma. Basal cell carcinomas are common, low-grade tumors that rarely metastasize but will continue to enlarge and become locally destructive. For extremely large tumors removal and reconstruction becomes a great challenge. Here we report a case of a BCC on the shoulder of an 87-year-old female and the utility of using a combined purse string closure with fish skin xenograft* after MMS. Methods: Our patient presented to the clinic with a large 15cm x 12cm ulcerated plaque with an erythematous border on the right anterior shoulder that was present for 5 years. Shave biopsy revealed an infiltrative basal cell carcinoma. The lesion was treated with MMS. After clearing the lesion, she was left with a 16cm x 13cm defect. The defect size was reduced utilizing a purse string suture, followed by application of an omega-3 fish skin xenograft designed to expedite healing. This graft was applied over the subcutaneous fat, moistened with saline, layered with non-adherent padding and adhesive strips, followed by gauze and stretch tape. The graft was removed and re-applied at 1-week intervals for a total of 7 weeks. Results: After purse string closure and 7 applications of omega-3 fish skin xenograft, the patient’s wound healed completely with preservation of function and an acceptable cosmetic outcome. Discussion: Omega-3 fish skin xenografts are FDA-approved for the treatment of chronic wounds. It is an acellular dermal matrix from Atlantic cod with a uniquely preserved porous microstructure similar to human skin. Advantages of using these grafts include their ability to decrease inflammatory cytokines, bacteria, and viruses, while increasing angiogenesis. They are useful for large defects and help facilitate an environment for cell ingrowth and wound healing in the skin. The fish skin xenograft has been noted to be more affordable compared to acellular dermal matrices originating from other sources. Use of an omega-3 fish skin xenograft has the potential for superior repair outcomes particularly when dealing with large wounds. Trademarked Items: * Kerecis References: