Ajapnyak Medical Center, Yerevan 0038, Armenia.
Kerecis LLC, Staff Specialist Landspitali University Hospital Reykjavik Iceland, Reykjavic, Iceland.
Mil Med. 2023 Nov 3;188(11-12):e3377-e3381. doi: 10.1093/milmed/usad028.
The 2020 Nagorno-Karabakh war was an armed conflict between Azerbaijan and Armenia over an ethnically and historically significant region. This manuscript is a report on the forward deployment of acellular fish skin graft (FSG) from Kerecis™, a biologic, acellular matrix derived from the skin of wild-caught Atlantic cod that contains intact epidermis and dermis layers. The usual intention of treatment under adverse circumstances is to temporize wounds until better treatment can be attained, although ideally, rapid coverage and treatment are necessary to prevent long-term complications and loss of life and limb. An austere environment, such as the one experienced during the conflict described here, presents considerable logistical barriers for the treatment of wounded soldiers.
Dr H. Kjartansson from Iceland and Dr S. Jeffery from the United Kingdom traveled to Yerevan, near the heart of the conflict, to deliver and train on using FSG in wound management. The primary goal was to use FSG in patients where stabilization and improvement in the wound bed were needed before skin grafting. Other goals were to improve healing time, achieve earlier skin grafting, and have better cosmetic outcomes upon healing.
Over the course of two trips, several patients were managed with fish skin. Injuries included large-area full-thickness burn and blast injuries. Management with FSG induced wound granulation several days sooner in all cases, and even weeks in some instances, allowing a stepdown in the reconstruction ladder with earlier skin grafting procedures and a reduction in requirement of flap surgery.
This manuscript describes a successful first instance of forward deployment of FSGs to an austere environment. FSG, in this military context, has shown great portability, with easy transfer of knowledge. More importantly, management with fish skin has shown faster granulation rates in burn wounds for skin grafting, resulting in improved patient outcomes with no documented infections.
2020 年纳戈尔诺-卡拉巴赫战争是阿塞拜疆和亚美尼亚之间围绕一个具有重要种族和历史意义的地区爆发的武装冲突。本文报告了一种名为 Kerecis™的脱细胞鱼皮移植物（FSG）的前置部署情况，Kerecis™是一种生物制剂，是从野生大西洋鳕鱼皮中提取的脱细胞基质，含有完整的表皮和真皮层。在不利情况下治疗的通常意图是使伤口暂时愈合，直到可以进行更好的治疗，尽管理想情况下，为了防止长期并发症和丧失生命和肢体，需要快速覆盖和治疗。在本文所述冲突期间经历的严峻环境对受伤士兵的治疗带来了相当大的后勤障碍。
冰岛的 H. Kjartansson 博士和英国的 S. Jeffery 博士前往位于冲突中心的埃里温，提供并培训使用 FSG 进行伤口管理。主要目标是在需要皮肤移植之前，在需要稳定和改善伤口床的患者中使用 FSG。其他目标是缩短愈合时间，更早地进行皮肤移植，并在愈合后获得更好的美容效果。
在两次旅行中，有几位患者接受了鱼皮治疗。损伤包括大面积全层烧伤和爆炸伤。在所有病例中，FSG 治疗可使伤口肉芽形成提前数天，在某些情况下甚至提前数周，从而可以降低重建阶梯，更早地进行皮肤移植手术，并减少皮瓣手术的需求。
本文描述了将 FSG 成功前置部署到严峻环境的首例实例。在这种军事背景下，FSG 具有很好的便携性，易于知识转移。更重要的是，在烧伤伤口中，鱼皮管理可使肉芽形成更快，从而改善患者的预后，且无记录的感染。
