Use of Acellular Skin Graft for Surgical Wound Following Lower Extremity Crush Injury
Post-operative infection with exposed hardware is often difficult to manage. After the infection has been resolved, there is still concern about coverage for the bone and whether to remove exposed hardware. Tissue grafting, flap closure, and negative pressure therapy have been some of the traditional options.
A 50-year-old male with a history of crush injury by skid loader to left foot with multiple subsequent surgeries presented to hospital 8 weeks status post most recent surgery with infected surgical wound dehiscence and exposed hardware. He was placed on IV antibiotics and taken for incision and drainage along with hardware removal and vancomycin impregnated antibiotic bead placement. The wound measured 11 x 1.5cm. MRI and bone scan demonstrated no osseous involvement of infection. Three days later the beads were removed and the first application of an acellular fish skin* was applied with wound VAC. An additional fish skin graft was placed 17 days later with continued wound vac therapy. Complete epithelialization of surgical wound was noted at 7 weeks following initial application of fish skin graft. There was no recurrence of infection.
Crush injuries of the lower extremity involving open fractures can be devastating to the patient and treating physician. Complications can include compartment syndrome, surgical wound dehiscence, as well as soft tissue and bone infection that can lead to amputation. The acellular fish skin wound matrix is a decellularized skin matrix derived from fish skin and represents an innovative concept to achieve wound healing and has demonstrated to the ability to heal many varieties of complex wounds. Studies have shown that omega-3 fatty acids possess antiviral and antibacterial properties and also act as regulators of inflammation. This case demonstrates the resolution of a large infected chronic surgical wound with two applications of an acellular fish skin wound matrix following eradication of infection.
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References (if applicable): 1. B. Dorweiler, T. T. Trinh, F. Dünschede, C. F. Vahl, E. S. Debus, M. Storck, H. Diener.Marine Omega-3 Wound for the Treatment of Complicated Wounds: A Multi-Center Report. Gefässchirurgie, 2017 Dec 1;22(8):558–67.
