(CS-078) Management of Sacral Decubitus Ulcers with Acellular Fish Skin Grafts– A Case Report

Sacral decubitus ulcer (SDU) reconstruction with primary closure and skin grafting continues to be a challenge due to low success and high recurrence rate. Free flaps are often chosen despite a high risk of complications associated with the surgery. We present a patient with a chronic SDU treated by an alternative method using Keresis acellular fish skin grafts (FSG) to achieve early full closure. Due to its native dermal structure, porosity, biomechanical properties and natural bacterial barrier rich in Omega3 fatty acids, the FSG will be able to facilitate the formation of granulation tissues and allow faster wound closure. 

Methods:

An 80 year-old male patient with stage 4 chronic SDU for 1.5 years was presented at the hospital along with several other medical conditions such as HTN, CVA, A-fib and Covid-19 infection. The initial SDU was 3.5 x 5cm and got abraded with scratch pad to expose a vascular wound bed. FSG was trimmed to size and placed directly on the wound followed by adaptic dressing and a wound vac. The vac was placed to -125mmHg suction and ensured a good seal. Wound vac was changed weekly at the clinic and serial dimensions were taken to monitor wound healing progression.

Results:

ignificant granulation tissue and coverage of wound depth was noted within the first month of application. The wound vac kept the wound clean and well vascularized which allowed for optimal healing. Over 6 months, the wound demonstrated complete wound closure after just one application of Kerecis FSG. 

Discussion:

Surgical management of SDU faces many complication risks such as wound dehiscence and ulcer recurrence, leading to higher rate of hospitalization and prolonged hospital stay. The above case represents an example FSG application in treating SDU. The acellular FSG provides a scaffold for cellular migration and proliferation, supports vascularization and formation of granulation tissues. The FSG was able to bring the wound to complete closure within 6 months without any further surgery or flaps. It appears to be a promising treatment option for chronic SDU and this example can provide future clinical and surgical guidance to practitioners with similar diseases. 

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