What is the Role of Fish Skin Graft in Combat Injuries in Austere Conditions? Editorial Summary Military conflict presents a series of challenges for clinicians when treating injured individuals. Blast injuries and burns are common, however access to standardized treatment remains limited in remote and resource scarce environments. Fish skin grafts (FSG) present a unique opportunity to treat both burns and blast injuries incurred in conflict where access to more usual treatments is more logistically challenging. This article will provide an overview of the potential use of FSG in military field hospitals to treat wounds.
Introduction
B
last injuries and burns are prevalent presentations in the context of conflict. Blast injuries result from exposure to a violent release of energy caused by explosions leading to widespread injury and disruption to multiple body systems. Thermal and chemical burns can be component features.1 The use of white phosphorus in combustibles contributes to the severity of chemical burns, which most commonly affect exposed skin on the face and hands. These wounds can result in significant morbidity and mortality. There is also an association with lengthy stays in hospital.2
Dr Fouad Reda
Managing such injuries during active conflict presents logistical challenges; they can often be highly complex and potentially fatal, requiring urgent action by the clinician to avoid loss of life or life changing injury. Circumstances themselves are challenging with potential ongoing enemy action against both civilians and military personnel.1 Additionally, conditions for storage of equipment for the treatment of injured soldiers is often sub-optimal.
Plastic Surgeon, Ajapnyak Medical Center Yerevan, Armenia
Cadaver skin is the favoured cover for severe burns in the hospital environment; however, this is not practical in austere settings like combat zones and so attempts have been made to address the problem. Cellular derived alternatives are similarly unsuitable due to their storage requirements.3 For example, ultra-low cold storage of allograft is unlikely to be available.4 Therefore, alternative treatments which provide readily accessible and low maintenance options for medical application must be sought.
Dr Hilmar Kjartansson
Dr Steven Jeffery
Kerecis LLC, Staff Specialist Landspitali University Hospital
Consultant Plastic Surgeon
Reykjavic, Iceland
Birmingham, United Kingdom
44
Wound Masterclass - Vol 2 - March 2023
Fish Skin Grafts Fish skin has the potential for use in the management of combat related wounds. Acellular matrix derived from the skin of wild-caught Atlantic cod has been developed as a patented graft material, or FSG, by Kerecis™ (Kerecis Omega3, Kerecis, Isafjordur, Iceland). FSG is supplied as a thick sheet with the indications for use given by the manufacturer including partial
© Copyright. Wound Masterclass. 2023