Acellular Fish Skin Graft Use in Open Abdomen Management.

Abstract

Open abdomen (OA) management post damage control laparotomy (DCL) is common in complex abdominal trauma and intra-abdominal catastrophe (IAC). Use of polyglactin 910 mesh (VICRYL™, Johnson & Johnson, New Brunswick, New Jersey) to cover the intra-abdominal contents and wound vacuum-assisted closure (VAC) is current practice in the management of temporary abdominal closure (TAC). This may have complications and requires two to three weeks for granulations to be ready for skin grafting. Acellular fish skin graft (AFSG; Kerecis™, Reykjavik, Iceland), use in wound care management has proven beneficial in the management of both chronic and acute wounds, such as burns, by increasing wound granulation. However, to our knowledge, its utility in OA management has not been reported. The objective of this report is to introduce a novel use of AFSG (Kerecis™) in open abdomen to decrease the time of TACs by accelerating formation of granulation tissue and placement of skin grafts in patients with post damage control laparotomy (DCL) for trauma and IAC when committed to open abdomen management is presented. Illustration of application of AFSG (Kerecis™) in two patients who underwent DCL for IAC and OA management is presented. Two patients with intra-abdominal catastrophe post-DCL and fistulae were enrolled; one with postoperative enteric fistula and the other with post-anastomotic ileo-colonic fistula breakdown and major intra-abdominal sepsis resulting in multiple organ system failure (MOSF). In both cases, a hostile abdomen was present. The application of AFSG accelerated the placement of skin grafts in both patients and decreased the use of wound VAC and hospital length of stay. This report illustrates the use of AFSG (Kerecis™) to accelerate placement of skin grafts in patients post-DCL and OA management. AFSG (Kerecis™) could be considered as part of the OA management strategy.