Dueppers Philip, Bozalka Roland, Kopp Reinhard, Menges Anna-Leonie, Reutersberg Benedikt, Schrimpf Claudia, Moreno Rivero Francisco Jose, Zimmermann Alexander
Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland.
Tissue Viability Service (Wound Care), University Hospital Zurich (USZ), Raemistrasse 100, CH-8091 Zurich, Switzerland.
J Clin Med. 2023 Sep 16;12(18):6001. doi: 10.3390/jcm12186001.
BACKGROUND: Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient's life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs. CASE PRESENTATIONS: We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis Graftguide) and one self-meshed 300 cm iFSG (Kerecis Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes. CONCLUSIONS: iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well.
背景：坏死性筋膜炎（NF）是一种严重的传染病，最初会危及患者生命，在成功进行手术和抗生素治疗后，会留下大面积伤口，有时甚至骨头和肌腱外露。自体皮肤移植并非总是可行，或需要对伤口床进行充分准备。新型完整鱼皮移植物（iFSGs；Kerecis Omega3 Wound，Kerecis hf，冰岛伊萨菲厄泽）已在许多其他伤口情况中显示出促进肉芽形成的潜力。由于其额外假定的抗炎和止痛特性，观察到伤口愈合速度更快，功能和美容效果更好。因此，iFSGs在治疗NF中可能也至关重要。我们介绍了我们使用iFSGs治疗NF后腿部伤口的初步经验，并回顾了有关iFSGs当前临床应用范围的文献。 病例介绍：我们介绍了两名男性患者（年龄分别为60岁和69岁），分别在坏死性筋膜炎后六周和六天出现慢性或急性术后腿部广泛溃疡。两人均患有糖尿病，下肢无血管病变。在广泛的手术清创和单周期负压伤口治疗后，我们在手术室中分别应用了一片预制成网状的（Kerecis Graftguide）和一片自行制成网状的300平方厘米iFSG（Kerecis Surgiclose）。应用和操作都很容易。即使在胫骨和肌腱未覆盖的情况下，也观察到了出色的伤口肉芽形成，两名患者均伴有疼痛缓解。未发生并发症或过敏反应。患者接受了自体皮肤移植，功能和美容效果极佳。 结论：由于能快速促进伤口肉芽形成和缓解疼痛，iFSGs在未来NF治疗中可能发挥重要作用。我们的经验可能会鼓励外科医生在NF患者中使用iFSGs，尽管仍需要高质量、大规模的研究来证实这些结果。iFSGs对与NF相关伤口的观察效果也可能适用于其他伤口病因。
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