503 The Use of Piscine Allograft in the Treatment of Superficial Burns and Split Thickness Skin Graft Donor Sites

Abstract

Fish skin is similar to human skin due to evolutionary homology. When processing mammalian xenografts harsh detergents are used that remove soluble skin components leaving behind an inert matrix of structural proteins only. As no disease transmission risk exists between codfish skin and humans, costly viral screening and viral-inactivation with detergents is not performed preserving the natural three-dimensional structure of the fish skin that is lost in other products derived from mammalian tissues. Due to its source, fish skin is naturally rich in anti-inflammatory omega-3 polyunsaturated fatty acids. In the human body, omega-3 polyunsaturated fatty acids are precursors to the resolvins, protectins, and maresins collectively known as Specialized Pro-resolving Mediators (SPMs). These SPMs are important in re-establishing homeostasis and resolution in wounds and favourable effects on host defence, pain and their ability to induce anti-inflammatory and pro-resolving signalling pathways. As superficial burns and split-thickness skin graft donor sites are notoriously painful, we decided to investigate the utility of fish skin dressings in a pilot study prior to performing a Randomised Controlled Trial. Ten patients with partial thickness burns were treated with fish skin dressings. Time to healing was recorded, and pain was assessed by using a visual analogue pain score after application of the dressing. A further ten patients who required the harvesting of a split-thickness skin graft were treated with fish skin as the donor site dressing. Pain was assessed with a visual analogue scale on the first post-operative day, and epithelialization was assessed calculating non-epithelialized areas with image software at day 14. All twenty patients had full healing of all wounds within three weeks, and pain scores were low. Fish skin dressings facilitate good wound healing and are very comfortable for the patient. Any patient with superficial burns or skin graft donor sites could benefit from this treatment.