Fish Skin Grafts Show Promise for Improved Diabetic Foot Ulcer Healing

Dardari D, Piaggesi A, Potier L, et al. Intact Fish Skin Graft to Treat Deep Diabetic Foot Ulcers. NEJM Evid. 2024;3(12).

Castellani L, Arruda S. Hooked on Healing—Fish Skin Grafts for Diabetic Foot Ulcers. NEJM Evid. 2024;3(12).

High-risk diabetic foot ulcers that involve deep structures such as muscle, bone, and joints are serious and can be life-threatening. Available data have shown that standard wound care (debridement, cleansing, skin grafting) results in complete healing in only 30% of patients after 3 months of treatment.

This article reported results of a randomized prospective trial that compared use of decellularized, lyophilized fish skin sheet grafts, made from Atlantic cod, with standard care for high-risk diabetic foot ulcers. The main outcome of interest was the rate of complete healing at 16 weeks.

Healing occurred in 44% of patients treated with fish skin graft and 26% of patients treated with standard wound care.

The authors concluded that fish skin graft treatment was associated with higher rates of complete healing and shorter healing time.

In the editorial that accompanied the article, Castellani and Arruda noted that these results are encouraging but adoption of fish skin graft treatment should be supported by evidence of cost effectiveness since the cost of the device is significant.