Fish Skin–Derived Wound Adjunct as an Alternative to Vacuum-Assisted Wound Closure for Contaminated and Infected Wounds

Abstract

INTRODUCTION: Vacuum-assisted wound closure (VAWC) is standard therapy for contaminated wounds. Fish skin–derived wound adjunct (FDWA) is used in wound care for contaminated wounds with great success. We postulated that FDWA would be an effective alternative, reducing overall cost and pain. METHODS: Our FDWA database of all patients where FDWA (Kerecis, Reykjavik Iceland) was placed intraoperatively was retrospectively reviewed to identify patients who met the criteria for the use of VAWC. Surgical wound infection (SSI) was defined as described by the CDC. Cost metrics were calculated based on actual cost for VAWC compared with the cost of FDWA. Before the use of FDWA, the average length of use for VAWC was 11.5 days. RESULTS: Fifteen patients (7 men: 8 women) with a mean age of 60 years (range 41to 84 years) and a mean follow-up of 29 days (range 6 to 59 days) were identified who met criteria. Level 1 criteria for VAWC were identified in 7 patients. Two or more level 2 criteria were identified in 8 patients. No SSI was identified in the FDWA patients (Table 1). The daily cost of VAWC is $111.18/day for a total of $1,278.57. The cost for a single application of FDWA is $890. Patients do not require any dressing changes in the FDWA group. Table 1. - Criteria for Vacuum-Assisted Wound Closure Level 1 Level 2 Risk factors No. of patients Risk factors No. of patients Extended duration of surgery 4 ASA physical status ≥ 2 14 Previous surgery at the site/multiple incisions 2 Age >65 y 5 BMI ≥40 kg 1 Steroids for a chronic condition 5 Regularly scheduled dialysis 1 Smoking 4 BMI (30–39.9) kg 3 Peripheral vascular disease 1 CONCLUSION: This pilot study suggests that FDWA is an effective alternative to VAWC with lower cost and less patient discomfort. Further study is needed to fully define the role of FDWA in the management of contaminated surgical wounds.