When Krystal DeVos watches her young daughter, Eliana, play with an Ariel doll, her eyes fill with emotion.
“I call her my little mermaid,” DeVos said of her daughter.
Shortly after Eliana was born, it was the healing power of fish skin that helped her recover from a deep wound on her neck.
“Eliana actually has no idea,” said DeVos, who lives in Corpus Christi, Texas. “Of course, as she gets older, we do want to go back and show her pictures and explain to her what has happened, because it is a part of her story and it’s so unique.”
Eliana’s story began about three years ago, when she was born at 23 weeks gestation, weighing a single pound. She spent 131 days in neonatal intensive care units, during which she developed a life-threatening infection on her neck that caused a severe wound.
“It was almost like a flesh-eating disease, where her body was targeting something there in her neck,” DeVos said.
As the infection grew, Eliana developed sepsis, the body’s extreme response to an infection, causing some of her organs to shut down. Day after day, DeVos and her family consistently prayed for Eliana to recover.
Then the medical team told her about a surprising treatment option.
On day 86 of her NICU stay, Eliana was transferred from her local general hospital to Driscoll Children’s Hospital in Corpus Christi. She received several medications to treat the infection at both hospitals, including antibiotic therapy. But it was at Driscoll that fish skin became a novel part of her wound care.
“It’s microscopically so close to human skin that it helps the wound start to heal,” said Dr. Vanessa Dimas, a pediatric plastic surgeon at Driscoll who treated Eliana.
Too fragile for traditional treatment
When Dimas first met Eliana, she knew that she would need to do two things: remove the buildup of dead skin tissue from the wound and cover it with some type of treatment to help healthy tissue grow back. But the more traditional approaches – like surgery or a human skin graft – were either too risky or not feasible for a preterm infant like Eliana. Her condition was too fragile.
“She was a premature baby, the wound was very extensive, and she was pretty sick, so I did not feel like it was safe to do a surgical procedure on her,” Dimas said.
Instead, Dimas and her colleague Roxana Reyna, a wound ostomy nurse practitioner at Driscoll, used a medical-grade honey solution to clean out the wound. Then they applied a mixture of that honey with fish skin to cover the area.
The fish skin – a medical product made from wild North Atlantic cod and manufactured by the Icelandic company Kerecis – provided a scaffold, or a type of platform, for new skin tissue to grow. Some of the omega oils and other natural elements from the fish skin helped contribute to the healing process, Dimas said, adding that “once it basically does its job, helping the wound heal, then it sort of just melts away.”
Potential risks of this fish skin treatment include reactions in children with fish allergies; for infants, it may not be known whether they have an allergy at all.
“That would be the biggest risk: an unknown allergy that could potentially cause some problems,” Dimas said. “Other than that, there’s still a chance that the kid may need surgery, because we don’t know how much this is going to help us heal the child.”
But for Eliana, the fish skin treatment was well-tolerated and appeared to promote healing.
The potential of ‘xenografts’
Fish skin has been used for wound care in people around the world, but its use in children – let alone infants – remains rare.
In March, Dimas and Reyna presented data about their approach for preterm infants at the European Wound Management Association Conference in Barcelona, Spain. They talked about two case studies: Eliana and a critically ill preterm baby with an abdominal wound.
“Eliana weighed 3 pounds on the day we applied the fish skin graft,” Reyna said. The other patient weighed 1 pound during their treatment.
“Since Eliana, now we have been able to feel confident enough to use it in even smaller babies,” Reyna said.
Driscoll Children’s Hospital says Eliana’s care team appears to be the first to implement Kerecis fish skin in wound care for a single-pound preterm baby.
Reyna and Dimas have been recognized for their work, and because of their innovative use of the product, Kerecis has invited them to share their clinical insights in public forums.
The concept of using fish skin to help heal damaged tissue in humans has been around for years, but it’s still not a very common practice, said Dr. Arun Gosain, chair of the American Academy of Pediatrics’ Section on Plastic Surgery and division head of plastic surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago.
“There are so many different options” for wound treatment, depending on the depth and severity of the wound, he said. Some approaches involve tissue from other types of animals.
“There are other forms of what we call xenografts, or taking tissue from another species and using it for wound healing,” said Gosain, who was not involved in Eliana’s case. For instance, skin from pigs has been commonly used in wound care, as well as collagen from cattle.
“Xenografts may have potential in the future, but they’re not used for skin replacement. It’s only used for a biologic dressing currently,” he said. Biologic dressings help to temporarily cover wounds and support the natural healing process, essentially aiding in either the wound healing on its own or preparing it for a surgical treatment to close it.
For example, someone who has a “full-thickness wound” – meaning it extends through all three layers of the skin – that isn’t healing on its own could benefit from some type of temporary biologic dressing, Gosain said.
In that scenario, “I could use pig skin,” he said. “We would put that on there as a biologic dressing, realizing that it won’t regenerate skin, but it will keep the wound clean until we’re ready to transfer the patient’s own skin, in some form, to close the wound, whether it be a skin graft or other such thing.”
‘Never be fearful to try something new’
In their case study, Reyna and Dimas described Eliana as having a “full-thickness wound,” but after three days of the fish skin treatment, they noted “dramatic results.” They continued to change her dressing every three days, and after the wound was cleaned and dead skin tissue had been removed, it healed in 10 days after the first fish skin mixture was applied, with minimal scarring, according to the study.
“There were no adverse reactions, and additional surgical interventions were unnecessary,” they wrote. Three years later, Eliana’s scar is so faint, it’s barely noticeable.
DeVos said she was inspired by watching fish skin promote the healing of her daughter’s wound, and she hopes Eliana’s story can help contribute to the world’s understanding of fish skin as a medical tool.
“What I hope people take away is that we can be grateful for modern medicine and the power of faith,” she said.
“Never be fearful to try something new. Always be open-minded and just have faith,” she said. “If something sounds different or you’ve never been exposed to it before, just take a chance and have a little faith. And in our case, it worked out really great.”