Successful Limb Salvage Using Staged Applications of a Fish-Skin Xenograft (Kerecis) in a Heel Pad Degloving Injury: A Case Report
Abstract
Introduction: Heel pad degloving injuries represent one of the most challenging problems in lower-extremity reconstruction because durable soft-tissue coverage must withstand repetitive weight-bearing while minimizing infection, wound breakdown, and limb loss.
Case report: We report the use of staged fish-skin xenograft reconstruction as a limb-salvage strategy in a 24-year-old man who sustained a severe heel pad avulsion with multiple open fractures of the foot and ankle following an all-terrain vehicle accident. Initial management consisted of serial irrigation and debridement, fracture stabilization, and negative-pressure wound therapy; however, progressive heel pad necrosis resulted in a 22 × 15 × 0.5 cm full-thickness plantar soft-tissue defect extending to the calcaneus despite aggressive wound management. The patient was subsequently counseled regarding below-knee amputation due to the severity of soft-tissue loss but elected to pursue limb salvage following multidisciplinary discussion of reconstructive options. Three sequential applications of a fish-skin acellular dermal matrix (Kerecis) were performed over 8 weeks, resulting in progressive granulation tissue formation and development of a robust, well-vascularized wound bed suitable for definitive reconstruction. Subsequent full-thickness skin grafting to the heel and split-thickness skin grafting to the surrounding soft-tissue defects achieved complete wound closure without infection, graft loss, or wound…
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