Investigating the Role of Fish Skin Grafts in Treating Complex Posterior Spinal Wounds

Complex wound management in spinal surgery poses significant challenges, especially in high-risk patients. Wound dehiscence, infection, and posterior hardware complicate healing. Intact fish skin grafts (IFSGs), derived from North Atlantic cod, have shown promise in reinforcing soft tissue due to their structural similarity to the human extracellular matrix, retention of polyunsaturated fatty acids, and antimicrobial properties. This study evaluates IFSG in reducing wound complications and facilitating healing in complex posterior spinal revisions and high-risk patients.

We performed a single-institution retrospective analysis of patients undergoing cervical, cervicothoracic, and lumbar revisions and high-risk patients undergoing cervical and lumbar closure, with IFSG placement by a single plastic surgeon between November 2021 and November 2023. Eligible patients were older than 18 years and followed up for at least 6 months postoperatively. All procedures involved meticulous debridement, muscle mobilization, IFSG application over the fascia, and standardized postoperative care, including wound vacuum-assisted closure and drain management.

Of 13 patients who received IFSG, 11 underwent revision surgery for spinal wound dehiscence, and 2 underwent primary cervical and lumbar closures. Four patients required posterior hardware coverage. The median age was 68 years (range 51-81 y), with 53% women. Wound sizes ranged from 5 to 1920 cm³. One patient developed a postoperative seroma, which resolved without surgical intervention, and the remaining recovered without complications.

IFSG offers a safe, effective option for managing complex spinal wounds. Its structural and biological properties support tissue repair and seem to reduce complications, making it a viable alternative or supplement for traditional wound management techniques.