(CS-144) Application of fish skin graft to salvage a complex foot wound with loss of the majority of the dorsum and heel of the foot resulting from necrotizing fasciitis

One of the primary goals for contemporary wound care is the ability to treat and salvage wounds that otherwise could not be treated. Successful treatment of complex wounds encourages practitioners to push further and attempted salvage of limbs that in the past would have been considered not possible to save. 

The addition of expanse meshed fish skin graft on the wounds caused a dramatic reversal and progressive improvement to complete healing.  

Methods:

The patient is 67 years old with type 2 diabetes mellitus and is a non-smoker.  He had presented with a serious foot infection and initially had debridement of both dorsal and plantar aspect of his foot along with the heel.  

He has been discharged to a skilled nursing unit on IV antibiotics with a negative pressure wound device Despite these appropriate care measures he presented 2 weeks after being discharged with his wound dramatically deteriorating.

He had expanse 8 x 10 applied over his wounds.   The expanse was stabilized with staples a nonadherent layer and then a  negative pressure wound device was reapplied.  After a 1 week period of time his wound looked dramatically improved.  Because of this he subsequently had expanse applied 3 additional applications over the next weeks. 

Results:

His wound had improved dramatically and the size had changed from the original dorsal wound being 8.4 cm x 5.5 in the heel being 5.2 x 6.  His heel wound had decreased to 1.5 x 1.7 and the dorsal wound had closed down to 0.2 x 0.2 x 0.1 over a period of 5 months.  At this point he presented with an area of induration and erythema along his posterior mid- calf area which I had drained under local anesthesia and debrided which I think represented an area  of  the necrotizing fasciitis that had not resolved completely.

The wounds went on to close.  His wounds have remained closed and he had retained full function of his foot and ankle area.

Discussion: This case illustrates that even the worst foot wounds that many people would abandon  as non-salvageable can be is saved now utilizing all the components of advanced wound care.  The fish skin product Kerecis has expanded treatment of these wounds to treat in this case a wound that was failing with all appropriate measures being done and resulted and salvage of the foot that has full function., and would otherwise have been lost.