Plaster made of fish skin heals chronic leg ulcers
Two years after she noticed a small wound, like a blood blister, on her right shin, Dela Hansford faced having her leg amputated. But if this outcome was unexpected, even more surprising was what saved Mrs Hansford from this drastic option: a piece of cod skin. She was one of the first people in Britain to have the radical new treatment.
In 2013, Mrs Hansford, 76, a widow from Hampshire, developed several ulcers on her leg.
‘The first appeared after I banged my leg on a chair in the September. It was like a blood blister and I thought it would go away,’ she says.
‘I kept it clean and looked after it, but it got bigger and about a month later I went to see my GP, who dressed it.’
But the wound didn’t heal — and then over six months, four others appeared.
‘They became very big, two were about the size of my palms and very deep, almost to the tendon.’
They were so deep that, in April last year, she was told amputation of her lower leg was a distinct possibility.
Chronic wounds are a major health problem. It’s estimated that at any one time, more than 200,000 patients are affected, and quite apart from the personal misery, the cost to the NHS of treating such wounds is as high as £3 billion annually.
Chronic wounds, defined as those that take more than six weeks to heal, include foot ulcers, a common complication of diabetes as a result of poor blood flow; pressure or bed sores; and leg ulcers caused by high blood pressure in the veins of the legs.
The latter, known as Martorell ulcers, are thought to be due to a narrowing of small blood vessels in the skin.
This results in a lack of blood supply and the skin tissue dying off.
ASTUDy at the University of California found one in three chronic wounds remains unhealed for at least six months and one in five wounds lasts for a year or more.
Delayed wound healing can lead to infection, amputation and even death as a result of a serious infection.
wounds can fail to heal for a variety of reasons, ranging from poor blood and oxygen supply, to weak immune system and low levels of growth factors, the compounds necessary for healing tissue. older people are particularly at risk.
There are four main stages in the wound-healing process.
First, red blood cells move in to form a blood clot to stop the bleeding and seal the wound.
Then, in the second stage, called i nflammation, white blood cells arrive to see off any infection that may have got through.
In the third stage, collagen, a protein that helps form the scaffolding of tissue, is delivered to replace lost tissue.
And finally, the outer skin layers then contract to close the wound.
However, with chronic wounds t he healing s t ops at t he inflammation stage.
This means that the matrix or scaffolding, normally formed of collagen, and around which cells gather and create new tissue to seal the wound, does not work properly, leaving it open.
There are a wide range of treatments f or chronic wounds, including new types of dressings and ultrasound ( thought to stimulate the healing process).
The new cod skin therapy, which was developed in Iceland, consists of a graft of specially processed, sterilised fish skin that’s placed on the wound.
This creates a natural scaffold to encourage the patient’s tissue to grow in and around it, completing the healing process.
The treatment, known as Kerecis omega3 wound, comes from cod farmed in the Atlantic off the north- west coast of Iceland. It i s processed to remove most of the fish cells, which leaves the connective tissue and fat behind, and then sterilised.
This graft is cut to fit the wound size and is placed over it, then covered with a traditional protective dressing.
Fish skin is largely made from the same material as human skin, and contains fats and proteins that help the body regenerate damaged tissue.
The fish skin also contains omega-3 fatty acids, compounds that help to reduce inflammation allowing the wound healing to progress normally.
Trials conducted by Kerecis, the Iceland- based company behind the treatment, have shown favourable results.
In a study published earlier this year in the International Journal of Lower Extremity wounds, the wounds treated with the fish skin closed faster than those treated with another type of biological graft. In another small study, ten patients with serious non- healing wounds received the treatment for 28 days. All the wounds treated improved, with six healing completely.
In a third study, none of the wounds had responded to hospital standard treatment for at least six months before the trial started.
In this study, which involved 37 patients, a year after treatment 36 of them had improved. Though the 37th did not improve, the wound did not get worse, according to Dr Baldur Tumi Baldursson, medical director of Kerecis.
Fertram Sigurjonsson, the chief executive of Kerecis, told Good Health: ‘Around 50 people in Britain have had the treatment. our product is t he standard treatment in Iceland for wounds that fail regular wound treatment.’
Another form of the technology, Kerecis omega3 Reconstruct, which is used to fix hernias and help with breast reconstruction, is still in human clinical trials.
The company is also working with the U.S. Department of Defence to develop this treatment’s use in the reconstruction of abdominal walls after bullet or DELA bomb injury.
HANSFORD heard about the treatment through her daughter, Pamala, who lives in Iceland, and says: ‘I suggested to my NHS consultant that we tried it.’
The treatment began in July last year.
‘It made a massive difference,’ says Mrs Hansford. ‘The ulcers started healing straight away — you could see changes almost within days.
‘Four have healed and one is on the way to healing — it’s less than half the size it was. As soon as they started the treatment, I could feel myself getting better.’
A year on, Mrs Hansford still has fish skin put onto the remaining wound.
Commenting on the technology, Dr Bav Shergill, a consultant dermatologist at Queen Victoria Hospital NHS Trust in west Sussex, said: ‘This is an interesting new application for chronic wounds. I have seen similar products used to treat burns in Vietnam — they use frog skin with excellent results.
‘I am not clear on what happens to the fish cells. I would have thought they would be replaced by new human tissue.
‘Human skin grafts can also be helpful in treating wounds, too. In these cases, the grafts act as biological dressings to promote healing of chronic wounds.’