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Fish-Skin Grafts for Plastic and Reconstructive Surgery

Support Complex Closures. Restore Form and Function.
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As a plastic and reconstructive surgeon, you take on some of the most complex surgical procedures. You need a tissue-repair product that helps you navigate the reconstructive ladder with confidence to support patient outcomes in challenging cases.

Kerecis® intact fish-skin grafts provide the robust three-dimensional structure and natural molecular content needed to rapidly facilitate cellular ingrowth, maintain a bacterial barrier, and promote tissue regeneration.

Because Kerecis is minimally processed and retains the fish’s natural skin structure – which is remarkably similar to human skin – it integrates quickly, enabling you to reduce time to definitive reconstruction or unlock options lower on the reconstructive ladder.

Kerecis for Plastic and Reconstructive Surgery

Reconstruct over exposed structures [1]

Promote faster healing in compromised tissue beds [2,3]

Limit secondary contracture to optimize functional and cosmetic outcomes [4-6]

Reconstruct Over Exposed Structures, Including Bone & Tendon

Promoting granulation on surgical sites with exposed bone and tendon is a key challenge for plastic surgeons. Kerecis is indicated for use on full-thickness wounds with exposed bone and tendon and is clinically proven to fast-track healing on these tough sites, equipping surgeons to potentially reduce from flap to graft.

A 2024 multi-center RCT found that Kerecis products promoted faster healing for severe wounds with exposed bone and tendon compared to standard of care. [1]

Promote Faster Healing in Compromised Tissue Beds

Our fish-skin grafts’ intact ECM components help enhance healing in damaged or hypovascularized tissue beds by rapidly incorporating and facilitating cellular ingrowth,[2,3] creating a healthy area ready for closure by secondary intention, autograft, or flap.

Kerecis Fish-Skin Graft has Significantly More Cell Ingrowth than Amnion / Chorion Membrane

Quantification of fibroblasts (in blue, marked with arrows) that have infiltrated the fish-skin graft and the amnion/chorion membrane. There is significantly more cell ingrowth in the fish-skin graft.[3]
Human Amnion Chorion Membrane
Kerecis Fish Skin

Limit Secondary Contracture to Optimize Functional & Cosmetic Outcomes

Poor graft integration and disorganized tissue remodeling can compromise patient outcomes. Kerecis’ 3D tissue structure provides a robust platform for fibroblast infiltration, promoting fast integration. This may help limit scarring, adhesion, and secondary contracture, [4,5,6] which can help restore and maintain function such as range of motion.

Surgical sites treated with Kerecis have also demonstrated improved skin pliability, pigmentation, vascularity, and hydration levels.[6] A 2021 feasibility trial found that full-thickness burns treated with Kerecis had similar functional and cosmetic outcomes as burns treated with cadaver skin one year after treatment.[6]

5x
Kerecis + STSG at 1 year follow-up, showing Rete ridges that promote healthy mechanical properties and elasticity

Navigate the Reconstructive Ladder with Confidence

Kerecis fish-skin grafts can be used in a variety of plastic and reconstructive procedures, including trauma cases, head and neck reconstruction, wound dehiscence, necrotizing fasciitis, pressure ulcers, and hidradenitis suppurativa. No matter the procedure, Kerecis allows you to confidently navigate the reconstructive ladder to improve your patients’ outcomes.

See examples of how Kerecis can support you below.

Plastic and Reconstructive Surgery Case Studies

Elaina Yingnu Chen, MD
, Plastic Surgeon

Bridging to Skin Graft

Patient Presentation​

88-year-old female presented to ED as trauma after a motor vehicle crash. Sustained extensive degloving injury to BLE. ​

Underwent washout of LE wounds with placement of negative pressure wound therapy (NPWT) to both legs by general surgery on three occasions.

Surgical Intervention & Kerecis Application​

First Application: SurgiClose Micro and Meshed 2:1, done by plastic surgery​

Second Application: SurgiClose Meshed 2:1, done by plastic surgery​

Excellent take of Kerecis with nearly entirely covered patella tendon, muscle fascia, and tibia periosteum. Very minimal slough. Significant reduction in pain with NPWT dressing changes. ​

Clinical Outcome​

Patient had complete closure of entire wound, including areas of exposed patellar tendon, tibial periosteum, and exposed muscle fascia. Dramatic improvement in pain after Kerecis placement with decreased pain medication usage.

Bridging to Skin Graft
May 18
Initial presentation
Bridging to Skin Graft
June 26
SurgiClose Micro and SurgiClose Meshed 2:1 application​
Bridging to Skin Graft
July 5
SurgiClose Meshed 2:1 second application ​
Bridging to Skin Graft
July 10
Area prepared for STSG application ​
Bridging to Skin Graft
Sept 12
Final presentation, with full closure even over areas of exposed tendon and fascia.
Katherine Benedict, MD
, Plastic Surgeon

Healing by Secondary Intention

Patient Presentation

61-year-old female presented to the clinic on February 11 after multiple dog bites to left upper extremity, requiring multiple debridements – ultimately, resulting in a dorsal forearm wound and exposed extensor tendons. Reconstructive options with other skin substitutes had failed.​

Surgical Intervention & Kerecis Application

SurgiClose was used over the exposed extensor tendon on the dorsal forearm without overlying peritenon. Kerecis was not applied to the remainder of the wound bed as it had healthy granulation tissue.

Clinical Outcome​

The patient’s wound healed with no pain and minimal loss of wrist or finger range of motion. Patient was highly satisfied.​

Trauma - Dog Bite
May 10
Initial presentation after reconstructive options with other skin substitutes had failed
Trauma - Dog Bite
May 10
SurgiClose application over exposed tendon​
Trauma - Dog Bite
June 27
Final presentation
Michael Lacqua, MD
, Plastic Surgeon

Primary Closure

Kerecis can be applied under the suture line to support reinforcement and reduce the risk of dehiscence. In the case series below, five patients undergoing pilonidal cyst excision fully healed with Kerecis placed as an underlay to the skin closure.

Patient Presentation

5 patients undergoing pilonidal cyst excision were included in this clinical series

All patients were male and the average age was 26 (range 22-29).

All patients received 2 grams of cephazolin preoperativel

Surgical Intervention and Kerecis Graft Application

SurgiBind reconstituted in a vancomycin/saline solution was placed as an underlay to the skin closure.

Clinical Outcome

All wounds healed uneventfully, and all sutures were removed at Day 10.

No wounds demonstrated any signs of infection or wound dehiscence.

This small pilot study suggests the possible role of full thickness fish skin underlay in preventing wound dehiscence in patients undergoing primary closure after pilonidal cyst excision

Initial Presentation
SurgiBind Application
Follow up
Final Presentation
Post Op Day 10
Kerecis is durable, reliable, and versatile. As a plastic surgeon, I encounter wounds of all different etiologies. This product allows me to use the product on pretty much any wound in the hospital or the clinic.
Mark Suski
, MD, FACS

Discover the Benefits

Important Information

This website and its content is not intended to provide diagnosis, treatment, or medical advice. Products, services, information, and other content provided on this website, including information provided directly or through links to third-party websites, are for informational purposes only. Information on this website should not be considered a substitute for professional advice from a healthcare provider. Always consult with a physician or other healthcare professional regarding any medical or health-related diagnosis or treatment options.

Products and their variations may not be available in all countries and could be known under different trade names. Products, product names, indications, and claims vary by jurisdiction. Always verify with your local healthcare professional and consult the printed package information before use. Information on this website may not be current and might not reflect the latest product labeling – please refer to latest IFU’s on the website. For questions about product availability, please contact your Kerecis representative or use the contact form on our website.

Products are derived from fish sources and should not be used in patients with a known allergy to fish or sensitivity to fish products. Note that fish allergy is distinct from shellfish allergy. Do not apply fish skin products over infected or deteriorating wounds until the underlying cause has been resolved.

SurgiClose Silicone and Shield products contain silicone and are not suitable for patients with silicone sensitivity.
SurgiBind is not indicated for procedures requiring load-bearing support, such as hernia repair, for intraperitoneal organ contact, or where a bridging effect is needed.
SurgiBind Tendon Protect is not indicated to replace or repair the damaged tendon or to reinforce the strength of any tendon repair.
Always follow the product’s labeling for indications and contraindications.

A surgeon must always rely on their professional clinical judgment when deciding whether to use a specific product for a patient. Kerecis does not dispense medical advice and strongly recommends that surgeons be adequately trained in the use of its products before employing them in surgical procedures. The information provided on this website is intended to demonstrate the product offerings and should not replace the package insert, product label, or instructions for use. For regulatory and medical practice reasons, product availability may vary by market. Contact your Kerecis representative for further clarification.

  • For single patient use only; do not reuse, reprocess, or re-sterilize.
  • Discard any unused portions of the product.
  • Sterile only if the package is unopened and undamaged.
  • Do not use the product if the package seal has been broken, unintentionally opened, or if handling has caused damage or contamination.
  • Do not use after the expiration date printed on the product label or packaging.
  • Remove all non-viable and necrotic tissue prior to application of the product.
  • Remove exudate and control bleeding prior to product application.
  • Do not use in patients with known fish allergies.
  • The product is not designed, sold, or intended for use except as indicated.
  • No clinical trials have been conducted in pediatric, pregnant, or breastfeeding populations.

1

Dardari, et.al. Intact Fish Skin Graft to Treat Deep Diabetic Foot Ulcers. The Odinn Trial.  NEJM Evidence, 2024: 5. DOI: 10.1056/EVIDoa2400171.

2

Yoon J, Dogeon Yoon, Lee H, et al. Wound healing ability of acellular fish skin and bovine collagen grafts for split-thickness donor sites in burn patients: Characterization of acellular grafts and clinical application. Int J Biol Macromol. 2022;205:452-461. doi:10.1016/j.ijbiomac.2022.02.055 5.

3

Kotronoulas A, Jónasdóttir HS, Sigurðardóttir RS, Halldórsson S, Haraldsson GG, Rolfsson Ó. Wound healing grafts: Omega-3 fatty acid lipid content differentiates the lipid profiles of acellular Atlantic cod skin from traditional dermal substitutes. J Tissue Eng Regen Med. 2020;14(3):441-451. doi:10.1002/ term.3005

4

Lacqua, M et al (2021). The use of intact fish-skin wrap in preventing adhesions  during tendon repair: A report of two cases. Edorium J Orthop 2021;7:100018O03ML2021.

5

Wallner, C. et al. (2022). The use of intact fish skin as a novel treatment method for deep dermal burns following enzymatic debridement: A retrospective case-control study. European Burn Journal, 3(1), 43–55.

6

Shupp J, McLawhorn M, Moffatt L (2021). Fish Skin Compared to Cadaver Skin as a Temporary Coverage and Wound Bed Preparation for Full Thickness Burns: An Early Feasibility Trial. J Burn Care Res. 42:S124-S124. doi:doi:10.1093/jbcr/irab032.201

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From the town of Ísafjörður in northwest Iceland, Kerecis develops, manufactures, and distributes patented fish-skin medical devices that support soft tissue regeneration in the body, with regulatory clearance in the United States, Europe, and beyond.