A New Boundary in Wound Healing with a Fish-Skin Derived Acellular Dermal Matrix (Clinical and Histological Outcomes): a Case Series

Background. If an injury is left untreated or the treatment is not appropriate or the patient has adverse underlying conditions, the outcome of wound healing can be inappropriate, causing to the patient physical and psychological issues. To prevent an unsatisfactory healing, plastic surgeons can employ many tools; one amongst those are Acellular Dermal Matrixes (ADMs) that, as the name itself suggests, will promote the regeneration of soft tissues temporarily replacing the dermis until autologous components will fill the wound. Aim. The objective of the study was to analyze a novel fish-skin derived acellular matrix for the treatment of wounds, as a possible alternative to the dermal substitutes which have been used thus far. In a 1-year follow-up, the outcome was studied both clinically and histologically. Methods. 6 patients met the inclusion criteria and were treated with the fish-skin bioinductor, for a total of 8 applications. Results. In all the patients, for the first week after surgery the fish-skin derived bioinductor was visible at the base of the wound and after it’s reabsorption, the wound was covered with granulation tissue. 4 out the 6 treated patients had a favorable outcome and an appropriate healing process; in contrast, 2 patients after the initial promising uptake, 2 weeks after surgery had no withstanding granulation tissue visible but rather did have necrosis or bone exposure. Conclusions. Fish-skin bioinductor is a novel acellular dermal matrix that showed promising results in wound treatment, for its versatility and for the results obtained with the new formed skin. Further studies will be necessary to learn how to avoid future failure; for Padova’s experience, the application is not indicated for patients with high risk of bone exposure or with poorly vascularized ulcers.