In my hospital we have ample experience with another technique using polypropylene sheets for defect coverage, popularized in Brazil orthopedics as "Figueiredo's technique", which is in practice an extension of common techinques for temporary closure of abdominal wall ("Bogota's bag").
We put a transparent polypropylene sheet as skin replacement, suture it directly to the skin. We can monitor the wound and its secretions, can cover exposed tendons and bones without immediate doing microsurgical flaps. For example, we can monitor the second intention skin closure with reduced infection and analgesics use, sometimes without needing a graft at all.
There is an Icelandic company called Kerecis that produces these kinds of fish skin based grafts. There are some videos of some of their patient's before and after over at their webpage[0] but be warned, they might be a bit graphic for some.
[0]: https://kerecis.com
They used this exact treatment in an episode of The Good Doctor, S01E06. Original air date: October 30, 2017
Yes, but the treatment has been devised way prior to 2017.
They also used it in Grey's Anatomy S15E17 (2019).
I was thinking same, Jared saving that girls skin after burn.
I thought this a pretty mature technique? I have seen more than once our local vet using this technique to treat cats with large wounds -- with great results by the way. Interestingly, they too used tilapia fish skin, and not any of the more common local fish species. I wonder if there is something special about tilapia fish skin, or it was simply the species on which the technique was developed, and nobody bothered to try using other fish species.
> I thought this a pretty mature technique? […]
Yes, it is very mature. The article was written in 2017.
Tilapia are cheap and abundant, and the skin is an industrial-scale waste product.
They're incredibly hardy, and unlike most other food fish you can easily grow them in simple container setups.
No need for antibiotics because the fish got ample amounts while growing up in the farm.
What's special is that tilapia is probably cheaper than even the local fish since it's farmed in massive quantities and shipped all over the world as food.
If other fish skins were tried it must have been similar results.
Tilapia imports are heavily restricted to Australia, The live fish will not be allowed, they are considered "restricted noxious fish".
The rules are:
Illegal to Keep: You cannot keep tilapia (dead or alive), sell them, give them away, or use them as bait.
Immediate Euthanasia: Humanely kill the fish as soon as you catch it.
Disposal:
Bury: Bury them deep and well away from the water's edge to prevent scavengers from dragging them back in or floodwaters from releasing eggs.
Bin: Place them in a rubbish bin.
No Filleting: You cannot take fillets and dispose of the rest; the entire fish must be destroyed.
Various state departments have hotlines for reporting tilapia.
There are different hotlines per state:
Queensland Department of Agriculture and Fisheries (DAF) (13 25 23)
New South Wales Department of Primary Industries (DPI) (1800 675 888)
Victoria (VFA) Reporting hotline (13FISH or 13 34 74)
Western Australia Dept. of Primary Industries & Regional Development (1800 815 507)
I've had rewards for reporting them (fishing reel, free bait, etc).
For those that don't know why, and I didn't, the reason for this is that Tilapia are "mouth brooders", that is they keep the fertilised eggs in their mouth. So throwing away a dead female can cause these eggs to hatch, and reinfect the waters with new Tilapia.
Where I grew up (in northern Australia) a lot of people targeted and ate tilapia out of local estuaries .. there were a lot of them and they were big.
It's probably a mix of "this species happens to be unusually well-suited" and "this is the species people bothered to study rigorously first."
In Chinese villages, I've seen them use fish skin, potato skin, various leaves, cooked birds nest, fish fin oil, and etc to treat open wounds instead of pure bandaging.
While it's not a new technique, it's fascinating for this area to be further explored.
In a way this feels less like inventing something new and more like rediscovering and formalizing old techniques with modern safety constraints
It's old news. There is even “And Dream of Sheep” — Grey’s Anatomy, Season 15 Episode 17. That’s the episode where they mention using tilapia fish skin to treat burns. Original U.S. air date: March 14, 2019.
Doesn't make it any less interesting. And in spite of it not being new, it doesn't look like it's out of the experimental stage: the article mentions it's difficult to get the tilapia skin processed and sterilized.
The article is 9 years old so that may no longer be the case
Old news comes off dismissive. Doesn’t have to be a brand new discovery to be noteworthy.
2019? I'm surprised they kept it running for that long.
It's still running - season 22 right now.
And a 2017 Good Doctor episode
This article is from 2017 - maybe should say so in the submission title?
Still, an interesting read
They did this in the Netflix One Piece series (with a yellowtail though)
TLDR;
Its a fantastic substitute for bandages in the sense that you don't need to take off the fish skin everyday.
Its also better are retaining moisture in the burn wounds than cotton badages.
No need for antibiotics, painkillers etc
Its also really cheap. Fish farms regard them as waste.
> Fish farms regard them as waste.
I have only seen tilapia sold whole - the skin is one of the best parts when you fry them.
Same here. Not with just tilapia, but pretty much every fish.
Will never be approved by the US FDA since it can't be patented.
Kerecis got FDA clearance in 2013, and then approval in 2016.
That's made from cod, and it appears they chemically modified it so that it can be patented https://www.kerecis.com/kerecis-receives-u-s-patent-for-fish...
They do this in Iceland too
(2017)
The fact that tilapia skin was basically waste, yet turns out to have higher collagen content, better tensile strength, and better moisture retention than human skin is kind of remarkable
great news for humans, bad news for fish
I'm pretty sure they've done this for decades. I seem to remember someone using potato skins like 30 years ago.
> I'm pretty sure they've done this for decades […]
Yes, the article you read is from 2017.
This has been going for long enough that there's been several metastudies debunking it. Was hyped in the news around 2017.
Fish skin or silver sulfadiazine had similar effects and to me are both approximating placebo from the studies I read. The fish does nothing for pain and no difference in the scarring time vs the silver ointments.
fish skin (rich in collagen) sounds like a version of collagen patch. And for collagen patch for example https://pmc.ncbi.nlm.nih.gov/articles/PMC3081477/ where despite the "Conclusion" the "Results" show that it helps (and one can also expect that collagen patching is starting point to engineering artificial skin) :
Results:
With two weeks of treatment, 60% of the ‘collagen group’ wounds and only 42% of the ‘conventional group’ wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of ‘collagen group’ wounds and 48 (80%) of ‘conventional group’ wounds were >75% healed (P=0.21). Eight patients in the ‘collagen group’ and 12 in the ‘conventional group’ needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility.
Conclusion:
No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients’ compliance and comfort.
i saw that episode of one-piece
> In the US, animal-based skin substitutes require levels of scrutiny from the Food and Drug Administration and animal rights groups that can drive up costs, Lee said. Given the substantial supply of donated human skin, tilapia skin is unlikely to arrive at American hospitals anytime soon.
This reminds me of Milton Friedman’s arguments against the FDA.
I wonder what’s the difference between countries that drives that. It’s not like Brazil doesn’t have its own FDA, which is much more strict than the US one, from what I know. Maybe some kind of lobbying? Or are animal rights group that much stronger?
I was having a conversation about this with my father-a retired pharmaceutical industry executive-a few weeks back, about why certain generic prescription medication formulations were unavailable in Australia yet sold in New Zealand. He explained to me that the Australian pharmaceutical regulator (the TGA) and its New Zealand equivalent (Medsafe) had very different regulatory philosophies. Medsafe, if a major international regulator (such as the US FDA or the EU’s EMA) had already approved something, they’ll just approve it too (“if it is good enough for them it is good enough for us”); the TGA’s attitude was very different, just because the FDA or EMA had approved it didn’t mean they automatically would, they wanted to analyse the safety data for themselves and make up their own mind. For blockbuster patented drugs, the extra regulatory cost of Australia was worth it, but for the long tail of miscellaneous generic formulations, the extra cost of dealing with the TGA could make some of them financially nonviable.
Medsafe's strategy only works so long as there is at least one stringent regulator though.
I would think for a country like Australia a more moderate approach would be to approve things that were approved by other countries and have been in use for some amount of time - say, 5 years or so - apart from the things they directly approve.
The actual drug my father and I were discussing was clonidine.
In the UK and New Zealand, they sell 25 microgram clonidine tablets; in Australia, the smallest dose on sale is 100 micrograms.
Clonidine is a very old drug – it was released back in the 1960s. The risks involved are very well understood (arguably the biggest risk is fatal overdoses, but patient/parent education is the accepted mitigation strategy.)
The issue is, in Australia, it is only approved for treating high blood pressure in adults. Paediatricians and child psychiatrists commonly prescribe it for ADHD, and for anxiety, aggression and insomnia (particularly but not exclusively in the context of ASD); in adults, it is prescribed to treat menopausal hot flushes and migraines – but all those indications are off-label.
And this is the problem – given the doses involved, 25 microgram tablets only really make sense for those off-label indications, there isn't much demand for them for treating adult hypertension. So to get the TGA to approve 25 microgram clonidine tablets, you need to prove to them that clonidine is safe and effective for one of those currently off-label indications. And that will cost a lot of money, and given it is a generic medication long out of patent protection, it isn't worthwhile. Whereas Medsafe quite possibly just decided "the UK approved it for X so we will too".
As a parent, both of whose children are prescribed clonidine, this annoys me – cutting tablets in half is no fun, and cutting them into quarters is even worse. Or I can get them compounded into liquid by a compounding pharmacist, which makes it easier to measure out smaller doses (I always get 25 microgram/ml), but that adds expense and time (the nearest compounding pharmacy is 15 minutes drive one way). I just wish I could get 25 microgram tablets, but they can't legally be sold in Australia–possibly I could ask our child psychiatrist to apply for special permission to import them from New Zealand, but the amount of bureaucracy involved probably isn't worth it, there's no guarantee the request would be approved, and it would be expensive (it wouldn't be covered by our national prescription drug insurance).
I imagine it is about this:
> But Brazil lacks the human skin, pig skin, and artificial alternatives that are widely available in the US.
This is not an improvement on existing methods (it may end up being, but that is not the motivation) but rather a case of it being all they have to work with.
Tilapia skin is probably better than no skin at all.
> This is not an improvement on existing methods... a case of it being all they have to work with.
But the article says Tilapia skin is better in multiple aspects:
> "We got a great surprise when we saw that the amount of collagen proteins, types 1 and 3, which are very important for scarring, exist in large quantities in tilapia skin, even more than in human skin and other skins," Maciel said. "Another factor we discovered is that the amount of tension, of resistance in tilapia skin is much greater than in human skin. Also the amount of moisture."
It says it's different to human skin in multiple aspects.
Do I need more collagen or more moisture in my skin? I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.
Maybe tilapia skin is better for people who spend 24 hours a day swimming in lakes.
> It says it's different to human skin in multiple aspects.
No it says "even more than in human skin and other skins". Not different.
> Do I need more collagen or more moisture in my skin?
For this context? Yes? Clearly the article answers that already. I even included in my first reply but you'll have a third chance to read it:
> ...which are very important for scarring...
And your attempt to move the goal post fails miserably as well. Or do you think humans evolved to perfection by thinking this:
> I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.
I don't think you are debating in good faith. Good luck.
I've read Dune - I know exactly where this is going. Please do not apply sand trout directly to you skin unless you are ready to control the spice.
The God Emperor of Brazil would be a brilliant satire. I look forward to the new fish speakers.
The power to destroy a thing is the absolute control over it.
This is quite old news. I've heard about this more than 10 years ago at least. It has been fairly successful since the beginning and I've heard it improved quite a lot