(CS-083) Fish Skin Substitute Used as Bridge Therapy to Split Thickness Skin Graft to Heal Exposed Achilles Wound in Post Operative Infection Achilles Repair With Initial Incision & Drainage.
Co-Author(s):
Patrick McEneaney, DPM; Rimvydas Statkus, DPM
Introduction: Patient presented post achilles repair with acute MRSA abscess. After Initial admission and incision and drainage, the achilles tendon was completely exposed in an uncontrolled diabetic patient with significant medial and lateral undermining.
Methods: Infection was initially treated with admission, IV antibiotics, and urgent incision and drainage. After Infection was stabilized, fish skin substitute was used to fill medial and lateral undermining and to achieve 100% granulation tissue over the fully exposed achilles tendon. A combination of particulate and sheet graft was used. Negative Pressure Wound Therapy was also utilized. Once 100% granulation was achieved over the tendon split-thickness skin graft was used to completely heal the wound without complications.
Results: Fish Skin substitute was successful in rapidly filling extensive medial and lateral undermining tissue and achieving complete granular coverage over the wound to facilitate the use of a split thickness skin graft. Patient healed despite poor glucose control, and location of the wound and exposed tendon at the watershed area of the achilles. Research has been shown to and was supported by patient experience to reduce pain scores, provide an antibacterial layer, and increase angiogenesis in an area of decreased arterial flow in the watershed area of the achilles to help facilitate wound healing.
Discussion: Fish skin substitute sheet grafting can rapidly achieve granulation over exposed tendon even in patients with significant barriers to healing. Combination therapy with fish skin particulate was successful in filling in extensive undermining medial and lateral as a result of the I&D. The substitutes also provided an anti-bacterial layer which reduced infection risk post I&D with exposed tendon. The addition of negative pressure wound therapy worked synergistically to help to facilitate the rapid granulation tissue formation in just 8 weeks and 2 applications of fish skin sheet substitute and only one initial application of fish skin particulate.
Trademarked Items: Kerecis Omega-3 MariGen and MariGen Micro
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