Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority Study
The extent and depth of burn injury may mandate temporary use of cadaver skin (allograft) to protect the wound and allow the formation of granulation tissue while split-thickness skin grafts (STSGs) are serially harvested from the same donor areas. However, allografts are not always available and ha...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/12/3/680 |
| _version_ | 1797241973804892160 |
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| author | Randolph Stone Emily C. Saathoff David A. Larson John T. Wall Nathan A. Wienandt Skuli Magnusson Hilmar Kjartansson Robert J. Christy Shanmugasundaram Natesan |
| author_facet | Randolph Stone Emily C. Saathoff David A. Larson John T. Wall Nathan A. Wienandt Skuli Magnusson Hilmar Kjartansson Robert J. Christy Shanmugasundaram Natesan |
| author_sort | Randolph Stone |
| collection | DOAJ |
| description | The extent and depth of burn injury may mandate temporary use of cadaver skin (allograft) to protect the wound and allow the formation of granulation tissue while split-thickness skin grafts (STSGs) are serially harvested from the same donor areas. However, allografts are not always available and have a high cost, hence the interest in identifying more economical, readily available products that serve the same function. This study evaluated intact fish skin graft (IFSG) as a temporary cover to prepare the wound bed for STSG application. Thirty-six full-thickness (FT) 5 × 5 cm burn wounds were created on the dorsum of six anesthetized Yorkshire pigs on day −1. To mimic the two-stage clinical situation, on day 0, wounds were excised down to a bleeding wound bed and a temporary cover (either IFSG or cadaver porcine skin) was applied; then, on day 7, wounds were debrided to a viable wound bed prior to the application of autologous 1.5:1 meshed STSG (mSTSG). Rechecks were performed on days 14, 21, 28, 45, and 60 with digital images, non-invasive measurements, and punch biopsies. The IFSG created a granulated wound bed receptive to the application of an mSTSG. FT burn wounds treated with an IFSG had similar outcome measures, including contraction rates, trans-epidermal water loss (TEWL) measurements, hydration, and blood perfusion levels, compared to cadaver skin-treated burn wounds. Pathology scoring indicated significant differences between the allograft- and IFSG-treated wounds on day 7, with the IFSG having increased angiogenesis, granulation tissue formation, and immune cells. Pathology scoring indicated no significant differences once mSTSGs were applied to wounds. The IFSG performed as well as cadaver skin as a temporary cover and was not inferior to the standard of care, suggesting the potential to transition IFSGs into clinical use for burns. |
| first_indexed | 2024-04-24T18:31:50Z |
| format | Article |
| id | doaj.art-ff01ed3755064572b9346d16350a36f0 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-04-24T18:31:50Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-ff01ed3755064572b9346d16350a36f02024-03-27T13:27:22ZengMDPI AGBiomedicines2227-90592024-03-0112368010.3390/biomedicines12030680Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority StudyRandolph Stone0Emily C. Saathoff1David A. Larson2John T. Wall3Nathan A. Wienandt4Skuli Magnusson5Hilmar Kjartansson6Robert J. Christy7Shanmugasundaram Natesan8Combat Wound Care Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USACombat Wound Care Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USACombat Wound Care Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USACombat Wound Care Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USAComparative Pathology Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USAKerecis<sup>®</sup>, 101 Reykjavik, IcelandKerecis<sup>®</sup>, 101 Reykjavik, IcelandCombat Wound Care Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USACombat Wound Care Research Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Houston, TX 78234, USAThe extent and depth of burn injury may mandate temporary use of cadaver skin (allograft) to protect the wound and allow the formation of granulation tissue while split-thickness skin grafts (STSGs) are serially harvested from the same donor areas. However, allografts are not always available and have a high cost, hence the interest in identifying more economical, readily available products that serve the same function. This study evaluated intact fish skin graft (IFSG) as a temporary cover to prepare the wound bed for STSG application. Thirty-six full-thickness (FT) 5 × 5 cm burn wounds were created on the dorsum of six anesthetized Yorkshire pigs on day −1. To mimic the two-stage clinical situation, on day 0, wounds were excised down to a bleeding wound bed and a temporary cover (either IFSG or cadaver porcine skin) was applied; then, on day 7, wounds were debrided to a viable wound bed prior to the application of autologous 1.5:1 meshed STSG (mSTSG). Rechecks were performed on days 14, 21, 28, 45, and 60 with digital images, non-invasive measurements, and punch biopsies. The IFSG created a granulated wound bed receptive to the application of an mSTSG. FT burn wounds treated with an IFSG had similar outcome measures, including contraction rates, trans-epidermal water loss (TEWL) measurements, hydration, and blood perfusion levels, compared to cadaver skin-treated burn wounds. Pathology scoring indicated significant differences between the allograft- and IFSG-treated wounds on day 7, with the IFSG having increased angiogenesis, granulation tissue formation, and immune cells. Pathology scoring indicated no significant differences once mSTSGs were applied to wounds. The IFSG performed as well as cadaver skin as a temporary cover and was not inferior to the standard of care, suggesting the potential to transition IFSGs into clinical use for burns.https://www.mdpi.com/2227-9059/12/3/680swineburn injuryskin regenerationcontractiontemporary coveringallograft |
| spellingShingle | Randolph Stone Emily C. Saathoff David A. Larson John T. Wall Nathan A. Wienandt Skuli Magnusson Hilmar Kjartansson Robert J. Christy Shanmugasundaram Natesan Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority Study Biomedicines swine burn injury skin regeneration contraction temporary covering allograft |
| title | Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority Study |
| title_full | Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority Study |
| title_fullStr | Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority Study |
| title_full_unstemmed | Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority Study |
| title_short | Comparison of Intact Fish Skin Graft and Allograft as Temporary Coverage for Full-Thickness Burns: A Non-Inferiority Study |
| title_sort | comparison of intact fish skin graft and allograft as temporary coverage for full thickness burns a non inferiority study |
| topic | swine burn injury skin regeneration contraction temporary covering allograft |
| url | https://www.mdpi.com/2227-9059/12/3/680 |
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