The Use of Acellular Fish Skin Grafts in Diabetic Foot Ulcers Management – a Systematic Review

Background: Diabetic foot ulcer (DFU) healing and management continue to be a major challenge for patients and healthcare providers, resulting in a considerable socio-economic burden. Lower-limb amputation is a severe clinical condition of DFU due to the presence of a chronic unresponsive diabetic foot ulcer with a high risk of infection, which raises morbidity and mortality rates. Rapid wound healing is necessary to prevent amputation. A recent advance in the development of applicable xenografts was acellular fish skin (AFS) grafts harvested from the North Atlantic cod (Gadus morhua) act as skin substitute, have a substantial lipid profile, primarily composed of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which have been shown to result in faster wound epithelialization, provide barrier protection against bacteria and alter the inflammatory profile of wounds. Due to these beneficial wound-healing properties, acellular fish skin might represent an effective treatment approach in chronic diabetic foot ulcer management.

Methods: A systematic review of the literature up to July 2023 was conducted using the electronic databases PubMed, Google Scholar, and ScienceDirect. Titles and abstracts were screened for the following key terms (variably combined): "fish skin", "fish skin grafts", "acellular fish skin grafts", "Omega3 Wound matrix", "Diabetic foot ulcer", "Chronic ulcer", "wound healing".

Results: The present study includes 12 trials that examined the effects of acellular fish skin grafts in diabetic foot ulcers. Compared to the standard of care, the use of acellular fish skin has been shown to accelerate wound healing resulting in reduced risk of amputation, reduced pain, reduced treatment-related costs, fewer dressing changes and improved quality of life.

Conclusions: Acellular fish skin xenografts may represent an effective, low-cost treatment of chronic diabetic foot ulcers.