The Application of Omega3 Fish Skin Graft in Nutritional Skin Failure Syndrome: Two Case Studies Editorial Summary Certain conditions can cause the nutritional system to be suppressed, thereby compromising the wound healing process for those subgroups of patients. This article provides a review of two of these types of patients, the application of the Omega3 fish skin graft and subsequent wound closure.
Introduction
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Dr Naz Wahab Wahab Consulting and Research Las Vegas NV, United States
kin, the largest organ of the body is also one of the most important. Comprising of many layers of skin cells, in distinct layers, in a constant renewal cycle. Within the layers of the skin cells in the epidermis and dermis are a network of blood vessels providing nourishment to the skin cells and the skin’s finely tuned nervous system with temperature, pressure and pain sensors, and oil and sweat secreting glands. Healing of the skin occurs from the deepest layer up, and from the edges inward. Initial stages of healing occur when basic connective tissue cells of the skin start the cycle for production of collagen, which nests in the wound area, thus building the framework to support the rebuilding of the skin. Once this collagen construct framework is in place, the expanding leash of blood vessels migrates to it. Enhancement of the blood supply enables the skin and nerve cells to follow. If the vital structures residing in the skin survive the trauma then hair pigment and the sweat glands may regenerate. Otherwise, the new ‘healed’ skin is deficient in these features. Human skin is a vital part of the body’s immune system, forming a physical barrier between external and internal environments. Adequate nutrition is required for this active immune organ to perform its physical barrier function. The growing incidence of chronic nonhealing wounds in aging and indigenous populations may result from a culture of poor nutrition, in what can be referred to as ‘nutritional skin failure syndrome’. Most wounds are partial thickness, i.e. involve only partial layers of skin. If the skin has a full thickness defect it may need to be addressed with an additional reconstructive option. Additional factors can affect the healing of large wounds such as infection, which can slow the
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Wound Masterclass - Vol 1 - September 2022
healing process. Wound healing in a normal state involves a delicate balance between nutritional intake and the body’s metabolism. A deficiency of nutrients (or an excess) can cause a disruption to this balance. A nutritional deficiency is most often encountered in patients from a lower socio-economic background, or sometimes the deficiency has a medical cause involving malabsorption, or for example, patients recovering from bariatic surgery. Psychiatric conditions such as eating disorders are a cause of insufficient nutrition, as are drug and alcohol addiction. A state of insufficient nutrition can be identifiable in symptoms of disorders of the skin.1 Challenging wounds, such as diabetic foot ulcers and venous leg ulcers, have a significant economic impact on healthcare and are associated with elevated patient morbidity. The added nutritional deficit adds an additional layer of challenge for the surgeon. Dermal and surgical application of minimally intact fish skin graft allows for the deposition of collagen and Omega3 fatty acids to the wound, aiding in reducing inflammatory response as well as providing nourishment to the skin, allowing for improvement in the environment that led to the chronic wound in the first place.