Fish Skin Graft for Tissue Regeneration of a Chronic Knee Wound: A Case Report

Background Chronic, non-healing wounds pose a significant clinical challenge, often associated with substantial morbidity. Biologic wound matrices have emerged as effective adjuncts in wound management, fish skin xenografts being one of these modalities. Fish skin xenografts, enriched with omega-3 fatty acids, provide a biologic scaffold that supports cellular infilration, angiogenesis, and tissue regeneration. Case Presentation Presented here is a case of a 53-year-old female with a chronic, non-healing left knee wound with exposed patella, patellar tendon, and orthopedic hardware following open reduction and internal fixation of a patella fracture complicated by surgical site infection. After a series of failed surgical debridements to achieve healing, a decellularized fish skin xenograft (Kerecis™) was applied following tangential debridement. Negative pressure wound therapy was used to promote graft adherence. Within two weeks, the wound demonstrated robust granulation tissue formation and improved vascularity, enabling definitive coverage with a split-thickness skin graft. The skin graft achieved 100% take, and the wound healed completely without complications. At two-month follow-up, the patient had returned to full functional activity. Conclusion This case demonstrates the clinical effectiveness of fish skin xenografts in promoting rapid granulation and wound bed optimization in a complex, chronic wound. Fish skin xenografts present a valuable treatment option and may serve as an effective bridge to definitive reconstruction in complex wounds.