Piscine-Derived Acellular Dermal Matrix in Upper Extremity Reconstruction.

Background: Wound reconstruction involving exposed critical structures, especially in medically complex patients and in those who are at high risk of loss to follow-up, presents a unique challenge to surgeons. The use of acellular dermal matrix (ADM) has augmented our ability to address these wounds safely and with minimal morbidity. A piscine ADM, the Kerecis Omega3 Wound, has shown promise in the treatment of chronic wounds and burns. In this study, we describe the use of the Omega3 Wound in reconstruction of upper extremity wounds, including those with exposed critical structures.

Methods: From 2019 to 2021, 11 consecutive patients with upper extremity wounds, including 9 with exposed critical structures, were queried. Clinical data was tabulated to evaluate outcomes.

Results: Etiology of the wounds included burns, trauma, infection, and oncologic resection. Wound surface area was 150 ± 42 cm². Time to incorporation of the Omega3 Wound was 2 weeks, and the vital structures of previously critical wounds were covered with granulation tissue. Clinically and histologically, the ADM became granulation tissue once incorporated. The average time from application to discharge was 6 days, with 3 patients discharged on the day of application. Skin grafting was subsequently performed at an outpatient surgical center, with 3 weeks as the average time to skin grafting.

Conclusions: The Omega3 Wound allows for complete biologic integration and vascularized wound coverage that accepts a skin graft. Patients can be discharged after application and managed at outpatient facilities. This ADM is safe and well tolerated by patients (including those who are diabetic and immunocompromised) for coverage of upper extremity wounds with exposed critical structures.