(CS-152) Management of an intractable ulcer of the achilles tendon with fish skin grafting: a case report
Thursday, May 16, 2024
7:30 PM – 8:30 PM East Coast USA Time
Introduction: Intact and micronized fish-skin grafts are being used to treat a variety of wounds to the lower extremity. These include wounds as a result of diabetes, venous, vascular, trauma and surgical. The minimal processing and ease of use for applications provide a viable option for the multiple wounds encountered at the wound center, hospital and office settings. The benefit for the patient when using a compatible xenograft is that this reduces the need for an autograft and the resultant additional wound.
Methods: 73-year-old male with a history of insulin dependent diabetes, ischemia to the left lower extremity which improved with angioplasty, cellulitis to the affected leg, and granuloma formation to the wound with exposed Achilles tendon. A mixture of 80mg of Gentamicin/100ml of Normal Saline was infused, which reduced the bioburden to the infected ulcer site. Micronized Fish-Skin graft was applied to the ulcer site and secured with a compression dressing. The patient related a significant reduction in the pain level after surgery. The dressings were changed two days later. There was a noted decrease in the erythema to the lower leg with early incorporation of the micronized graft.
The patient was returned to the operating room three days later. The wound bed was clear of the hypergranulation tissue with the wound bed measuring 8.5cm x 5cm x 0.2cm with decreased exposure of the Achilles tendon. The wound bed was prepped in the OR and was covered with intact Fish-Skin graft. The graft was secured and covered with a Wound Vac. There was additional improvement noted with increased epithelial and new granulation tissue present upon discharge from the hospital.
Results: The patient has been receiving care since then at the Wound Center with no need for additional grafts due to the continued improvement. The patient now has basic wound dressings applied to protect the affected site with no exposure of the Achilles tendon and a marked reduction in pain. No additional signs of infection are present. The patient has returned to most of his daily living activities.
Discussion: Skin ulcers over exposed Achilles tendon are challenging to heal with conventional standard of care. Ulcers can develop as a result of diabetes, trauma, venous insufficiency, arterial disease or pressure. A patient was referred to our service for an exposed Achilles tendon ulcer that had failed to resolve with conservative wound care and treatment with bi-layered skin substitute allografts.
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