(CS-143) Fish Skin Graft Application in Pediatric Deep Partial and Full-thickness Scald Burn Injury

Introduction: Burn care in the pediatric population can present even more complex challenges. Children have thinner skin than adults, predisposing them to a deeper burn for any given temperature. Over 450,000 individuals are hospitalized with burns annually, and roughly 35% are scald burns. Children younger than 5 years of age are at the greatest risk of scald burn injury.¹ The donor site availability is more limited in children, especially in more extensive area burns, with functional and cosmetic results more crucial due to continued growth. The feasibility of fish skin grafts are an innovative potential solution in pediatric burns is assessed in two scald injury cases.

Methods: Fish skin grafts were applied in two pediatric patients presenting with deep partial burn injuries when skin autografting was not a feasible option. The first patient is a 4-year-old female with 18% TBSA mixed partial-thickness scald burn to face, bilateral upper extremities, chest, and abdomen. The patient’s parents did not consent to the autograft procedure. The patient received two applications of fish skin graft 16 days apart in conjunction with VAC. The second patient 4-year-old male, scalded by boiling water, suffered full and partial thickness burns over 40% of the body. Fish skin grafts were applied to the the superficial and deep partial thickness burned areas of the chest and abdomen achieving full healing. Full thickness areas over his back and thighs were managed with excision and split thickness skin graft.

Results: Fish skin graft showed accelerated healing results and epithelialization as early as 7 days in both patients. Both patients have had an excellent function and cosmetic results, with evidence of remodeling. The first patient showed excellent re-pigmentation of the site of burn injury at day 60 after the initial injury. Additional observational findings of pain reduction were also noted.

Discussion: Fish skin grafts are a feasible management option in pediatric deep partial burn where the route to healing by secondary intention is considered or where autograft sparing methods need to be applied.