The Reconstructive Ladder Meets Marine Biotechnology: Acellular Fish Skin Grafts and Negative Pressure Wound Therapy for Complex Pediatric Foot Trauma: A Two-Case Report and First Institutional Experience
A. Fikry
*
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
H. Lahmidi
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
S. Karti
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
J. Latif Idrissi
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
S. Arguig
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
M. Habla
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
El youssoufi
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
S. Sabur
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
A. Harti
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
M. Diouri
National Burn Center and the Plastic, Reconstructive and Aesthetic Surgery Department, Ibn Roch University Hospital, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Complex pediatric foot trauma with exposed deep structures presents a major reconstructive challenge. The classical answer—flap reconstruction—carries donor-site morbidity, long operative times, and intensive monitoring poorly suited to young children and to resource-limited public hospitals. Intact acellular fish skin grafts (AFSG) derived from Atlantic cod (Gadus morhua) are an omega-3–rich biomaterial that preserves a native three-dimensional extracellular matrix and promotes rapid vascularization and granulation, without the zoonotic risk or harsh chemical processing of mammalian substitutes.
Case description: We report two boys treated at CHU Ibn Rochd, Casablanca, in what is, to our knowledge, the first use of AFSG at our institution. Case 1 was a 5-year-old with an 8 × 10 cm heavily contaminated dorsolateral foot defect after a motor-vehicle accident; after wound-bed conditioning, an AFSG was applied under continuous negative pressure wound therapy (NPWT) and a vascularized granulation bed was obtained within three days, allowing definitive split-thickness skin grafting (STSG), with closure approximately 18 days after injury. Case 2 was a 3-year-old referred with full-thickness dorsal necrosis after a failed degloving repair, with exposed navicular and cuneiform bone and extensor tendon loss; an AFSG under petrolatum gauze and NPWT produced granulation over bare cortical bone within four days, enabling immediate STSG and complete closure.
Conclusion: In both children, AFSG combined with NPWT rapidly converted complex bone- and tendon-exposing wounds into graftable beds, markedly shortening the time to definitive closure and avoiding free-flap reconstruction. Its principal limitations are limited local availability and high cost, compounded by the absence of insurance or hospital reimbursement coverage, which currently constrain routine use in our resource-limited setting.
Keywords: Acellular fish skin graft, Gadus morhua, pediatric foot trauma, negative pressure wound therapy, dermal substitute, reconstructive ladder, omega-3 fatty acids, case report.