Successful treatment of calciphylaxis in a renal transplant recipient with combination of intralesional sodium thiosulphate, intravenous sodium thiosulphate and fish skin graft

Tan, See Wei; Wong, Jolin; Kee, Terence; Chai, Zi Teng; Ho, Quan Yao; Chan, Michelle; Chew, Khong Yik; Oh, Choon Chiat

doi:10.1111/ajd.13556

Cited by 8 publications

(7 citation statements)

References 3 publications

(4 reference statements)

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“…; H2020-EU.2.1) and its French subgroup, the KereFish study, are anticipated to be published within this year [ 22 ]. Aside from the typical etiologies of chronic wounds, atypical wounds were successfully treated with iFSGs [ 15 , 33 , 34 , 35 ]. Etiologies included vasculitis, ischemic necrosis, necrotic angiodermatitis, calciphylaxis and hemophilia.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…The iFSGs are available in several sizes, shapes and variations, including pre-meshed or granulated products in the U.S. market, while the European CE certification of those pre-meshed and granulated products, as well as of larger fish skin grafts, is still pending. The clinical spectrum of iFSGs has been reported in several case reports up to prospective randomized-controlled trials and involves typical and atypical chronic wounds and traumatic wounds, including burns in adult and pediatric patients [ 15 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

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The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts

Dueppers,

Bozalka,

Kopp

et al. 2023

JCM

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Background: Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient’s life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis® Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs. Case Presentations: We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis® Graftguide) and one self-meshed 300 cm2 iFSG (Kerecis® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes. Conclusions: iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts

Dueppers,

Bozalka,

Kopp

et al. 2023

JCM

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Section: Introductionmentioning

confidence: 99%

“…Its occurrence in the transplant setting has been documented in case reports and registry data, but few reports exist regarding transplanted patients who have previously undergone total parathyroidectomy. 1 The pathogenesis remains incompletely understood, but involves calcification of small blood vessels within the dermis and subcutaneous tissues. Microthrombi develop, leading to tissue ischaemia and necrosis.…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of severe calciphylaxis in a renal transplant patient with previous total parathyroidectomy

Smith

Bulteel

Alfonzo

et al. 2023

Journal of the Royal College of Physicians of Edinburgh

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Calciphylaxis is a rare dermatological condition strongly associated with chronic kidney disease. The clinical course can be devastating, with high associated morbidity and mortality. The pathophysiology and optimum treatment remain uncertain. Calciphylaxis is known mostly to affect dialysis patients but is less frequently reported in renal transplant recipients. We report the case of a renal transplant recipient who had undergone previous total parathyroidectomy. Diagnosis was made at the time of limb amputation, yet despite this relatively late diagnosis she made a good recovery. We believe this resulted from a multi-modal approach including surgical debridement, sodium thiosulphate and vitamin K2 therapy. She remained free from recurrence 2 years after completion of treatment, despite on-going vitamin D replacement. There is much still to ascertain regarding calciphylaxis treatment, including the optimal regimens and duration of therapy, particularly in the transplant recipient population where data are limited.

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“…Due to these beneficial wound healing properties, Omega-3-rich AFS may be used in a broad spectrum of applications: Recent studies report good clinical outcomes after application in, e.g., chronic diabetic foot ulcers [ 13 ], calciphylaxis wounds [ 14 ], necrotic angiodermatitis [ 15 ], iatrogenic calcinosis cutis [ 16 ] or even for neovaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome [ 17 ]. AFS may also present an effective treatment option in burn wound management, since studies indicate accelerated wound healing, pain reduction, decrease in necessary dressing changes as well as treatment-related costs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Use of Acellular Fish Skin Grafts in Burn Wound Management—A Systematic Review

et al. 2022

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Background and Objectives: Burn wound healing and management continues to be a major challenge for patients and health care providers resulting in a considerable socio-economic burden. Recent advances in the development of applicable xenografts as an alternative to split-thickness skin grafts have allowed for the development of acellular fish skin. Acellular fish skin acts as a skin substitute, reducing inflammatory responses and advancing proinflammatory cytokines that promote wound healing. Due to these beneficial wound healing properties, acellular fish skin might represent an effective treatment approach in burn wound management. Materials and Methods: A systematic review of the literature, up to March 2022, was conducted using the electronic databases PubMed and Web of Science. Titles and abstracts were screened for the following key terms (variably combined): “fish skin”, “fish skin grafts”, “acellular fish skin”, “Omega3 Wound matrix”, “xenograft”, “burn injury”, “burns”. Results: In total, 14 trials investigating the effects of acellular fish skin in burn wounds or split-thickness donor sites were determined eligible and included in the present review. Existing evidence on the use of acellular fish skin indicates an acceleration of wound healing, reduction in pain and necessary dressing changes as well as treatment-related costs and improved aesthetic and functional outcomes compared to conventional treatment options. Conclusions: Acellular fish skin xenografts may represent an effective, low-cost alternative in treatment of superficial- and partial-thickness burns. However, results mainly originate from preclinical and small cohort studies. Future larger cohort studies are warranted to elucidate the full potential of this promising approach.

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Successful treatment of calciphylaxis in a renal transplant recipient with combination of intralesional sodium thiosulphate, intravenous sodium thiosulphate and fish skin graft

Cited by 8 publications

References 3 publications

The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts

The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts

Successful treatment of severe calciphylaxis in a renal transplant patient with previous total parathyroidectomy

The Use of Acellular Fish Skin Grafts in Burn Wound Management—A Systematic Review

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