Fish skin grafts are doctors’ new way to heal wounds on burn victims and diabetics

Medical experts prepare fish skin from wild cod — fished off the coast of Iceland — to apply on burn and diabetic wound patients.
Medical experts prepare fish skin from wild cod — fished off the coast of Iceland — to apply on burn and diabetic wound patients. Photo courtesy of Kerecis

Chilly waters off the coast of Iceland have yielded an unlikely tool for healing humans’ tough-to-treat wounds: the skins of wild cod.

After it’s cleaned, doctors can apply the fish skin to troublesome chronic wounds to ease pain and encourage human skin to heal underneath, according to Kerecis, an Icelandic company that makes several fish skin products and sells them across Europe, the United States and Asia.

“The skin of the fish, once scales are removed, is strikingly similar to human skin on a microscopic level,” Dr. Lee Rogers, a specialist podiatrist who has used the product on diabetic patients’ wounds, said in a phone interview with McClatchy.

One natural feature that makes cod skin special is its abundant Omega3 fatty acids, which help fight inflammation that might otherwise slow — or stop — the healing process, according to Rogers.

“When you get a cut, the surrounding area gets red because it’s the normal mechanism by which the body heals,” Rogers said. “People with diabetes get stuck in that inflammatory phase, and can’t get out of it.”

Fish skin has made headlines in the last year as a novel treatment for animals severely burned in California wildfires. After November’s Camp Fire in Butte County, veterinarians from the University of California, Davis, crafted little tilapia skin mittens and other dressings to help pet cats and dogs heal, McClatchy reported in a previous story.

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In earlier fires, California rescuers used tilapia skin treatments on bears and bobcats, too.

Those adorable kitten mittens drew tons of attention, even as a similar practice has been quietly spreading through doctors offices around the U.S. since Kerecis was founded in Iceland in 2009.

“I was interested in finding a source of material that is as similar to human skin as possible — and the surprising thing is that cod fish skin is much more similar to human skin than, for example, pig skin,” Fertram Sigurjonsson, CEO and founder of Kerecis, told Bloomberg.

Applying fish skin can help wounds get out of the inflammatory rut Rogers mentioned, which can help those suffering from diabetic foot ulcers heal — and help them avoid extreme measures like amputation, Rogers said.

Fish skin grafts created by Kerecis are being used and tested on diabetics and burn victims who have chronic or troublesome wounds. Photo courtesy of Kerecis

Treating those ulcers is especially important: More than four in five diabetic amputations come after a patient suffers from a foot ulcer, according to Mayo Clinic. As many as 80 percent of all diabetes-related foot amputations could have been prevented with appropriate treatment, the World Health Organization says.

Chronic wounds aren’t uncommon, either. As many as 4.5 million Americans suffer from chronic wounds, according to a 2018 article in the Journal of the American Medical Association.

That’s where skin grafts come in — and where fish skin has some advantages.

“Other treatments inhibit wound healing,” Rogers said. “This is the first that has Omega3 fatty acids that don’t inhibit wound healing.”

Kerecis fish skin products have also been approved by the FDA for treating second-degree burns, and MedStar Washington Hospital Center announced in November that it would be testing the product on deep third-degree burns. That trial is being sponsored by the U.S. military.

Skins grafts made from human skin, pig bladders or cow tendons are commonly used, but those have to be “virally inactivated” before they can be applied to humans so they don’t pass along unwanted diseases that spread from mammal to mammal, according to Rogers.

But virally inactivating the grafts from mammals comes at a price.

“When you’re disrupting those bonds because you’re using chemicals or radiation, it doesn’t maintain the same structure that it would have prior to that disruption,” Rogers explained. “The closer the bonds resemble human tissue, the less likely it is to be recognized as foreign.”

The FDA doesn’t require fish skin to be virally inactivated because there’s less risk of disease transfer, Rogers said. Fish skin also doesn’t come with the same religious taboos some faiths associate with pig or cow products, which are used in other grafts.

It’s not, however, without drawbacks.

Steven Jeffery, a British plastic surgeon who does burn care work, said he advises patients the treatment might smell a bit fishy — but that “it has the potential to be very useful,” Bloomberg reports.

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