From Debridement to Skin Grafting: Where Fish-Skin Xenografting Fits in Staged Reconstruction of Necrotizing Soft Tissue Infections.

BackgroundNecrotizing soft tissue infections (NSTIs) pose substantial reconstructive challenges, particularly in patients with significant comorbidities. Biologic fish-skin xenografts, which are decellularized and rich in polyunsaturated fatty acids, have anti-inflammatory and antimicrobial properties and have shown promise in complex wound management. However, published data remain limited.MethodsA retrospective review of nine patients with NSTIs treated between January 2024 and March 2025 at a single institution was conducted. All underwent serial debridements until wounds were free of gross infection and suitable for biologic grafting. A biologic fish-skin xenograft (mesh and/or granules) was applied to promote granulation. Data collected included demographics, comorbidities, wound size, number of debridements, operative time, total procedures, and time to definitive closure.ResultsThe mean age was 56.2 ± 11 years; 88% were female. Two-thirds had poorly controlled diabetes, and one-third were active smokers. Most wounds involved the groin or lower extremities; one involved the abdominal wall. The mean wound size was 718 ± 607 cm2. Patients underwent a mean of three debridements before xenograft placement and a total of five procedures before closure. Five patients (55%) achieved successful STSG at a mean of 50 days after xenograft application and 75 days after initial debridement. Of the remaining patients, one healed by secondary intention, one required amputation, one expired, and one was lost to follow-up.DiscussionBiologic fish-skin xenografts may be a useful adjunct to staged reconstruction of NSTI wounds in medically complex patients. Larger comparative studies are needed to further define their role.