Acellular fish-skin grafting complex soft tissue defects in orthopedic trauma: Technique and outcomes of a...

This article describes a surgical technique for applying an acellular fish-skin graft (Kerecis Omega3 Wound; Kerecis, Ísafjörður, Iceland) in orthopedic trauma and reports outcomes from a consecutive series of patients treated at an urban Level I trauma center. After institutional review board approval, we reviewed 27 adult patients with complex extremity wounds who were treated with acellular fish-skin grafting between January 1st, 2023, and December 30th, 2025. Wound etiologies included traumatic soft tissue injuries, postoperative wound dehiscence, necrotizing soft tissue infections, and chronic osteomyelitis with associated soft tissue compromise. Acellular fish-skin grafting was indicated in this series of patients for full-thickness skin loss (or deeper), including those with exposed tendons, bone, or ligaments, in whom flap reconstruction was contraindicated. Patients underwent serial irrigation and debridement followed by application of an acellular fish-skin graft. The primary outcome was complete wound healing without flap-based soft-tissue reconstruction. Secondary outcomes included the number of graft applications, duration of negative-pressure wound therapy (NPWT), time to split-thickness skin grafting (STSG), and all complications. Acellular fish-skin grafting facilitated wound healing in most patients, including those with infection, exposed bone, tendon, and/or ligaments, and substantial medical and social comorbidities. Twenty-two patients (84%) achieved definitive wound coverage without flap reconstruction. Five patients (19%) were referred to plastic surgery after grafting. Two ultimately achieved limb salvage with local wound care alone, whereas the remaining three required amputation. None of the referred patients were salvaged with flap reconstruction. One patient died on postoperative day two from unrelated medical causes, and one was lost to follow-up. Consequently, acellular fish-skin grafting may be a useful adjunct in managing complex orthopedic trauma wounds, particularly in high-risk patients or in settings with limited access to reconstructive surgery. Prospective comparative studies are needed to better define indications, effectiveness, and cost-effectiveness.