(CS-022) Non-healing Post Surgical Achilles Wound Treatment With Omega-3 Rich Fish Skin Xenograft

Trenton Leo, DPM

Introduction: Patient underwent Achilles tendon debridement and repair with a foot and ankle specialist which resulted in a non-healing surgical wound.

Methods: Wound was treated by the primary surgeon for 9 months. Wound care included serial debridements, wound care products such as silver and collagen, and allograft and xenograft applications. No improvement or healing during this time. Patient was referred to plastic surgery who recommend flap with external fixation. Patient deferred and was referred to a different foot and ankle specialist. Patient presented with initial wound measuring 2.5 cm x 1.5 cm x 1.0 cm with exposed Achilles tendon. Initial surgery performed for wound debridement with bone biopsy and wound cultures obtained. Following stable wound confirmation, there were 2 applications of fish skin xenograft over the course of 6 weeks. Patient maintained offloading in CAM boot and had wound care with either non-adherent dry sterile dressing or betadine.

Results: Patient underwent 2 fish skin xenograft applications with approximately 3 weeks between each application. Granulation tissue over the exposed Achilles tendon was achieved after first application. Second application led to complete healing of the wound. Healing was achieved by day 68 from initial application. No recurrence of wound as of 8 months post procedure.

Discussion: There is literature detailing the angiosomes of the posterior heel and Achilles area with recommendations on incision planning. It is a difficult area to heal, and wound management is challenging if it occurs. Fish skin xenograft is a viable option for challenging Achilles wounds with exposed tendon.