The unique biomechanical properties of the acellular fish skin graft make it ideal to be used as a conformal cover for severe trauma and burn wounds in the battlefield.

Thermal injuries are caused by exposure to a variety of sources, and split thickness skin grafts are the gold standard treatment for severe burns; however, they may be impossible when there is no donor skin available. Large total body surface area burns leave patients with limited donor site availability and create a need for treatments capable of achieving early and complete coverage that can also retain normal skin function. In this preclinical trial, two cellular and tissue based products (CTPs) are evaluated on twenty-four 5 × 5 deep partial thickness (DPT) burn wounds. Using appropriate pain control methods, DPT burn wounds were created on six anesthetized Yorkshire pigs. Wounds were excised one day post-burn and the bleeding wound beds were subsequently treated with omega-3-rich acellular fish skin graft (FSG) or fetal bovine dermis (FBD). FSG was reapplied after 7 days and wounds healed via secondary intentions. Digital images, non-invasive measurements, and punch biopsies were acquired during rechecks performed on days 7, 14, 21, 28, 45, and 60. Multiple qualitative measurements were also employed, including re-epithelialization, contraction rates, hydration, laser speckle, and trans-epidermal water loss (TEWL). Each treatment produced granulated tissue (GT) that would be receptive to skin grafts, if desired; however, the FSG induced GT 7 days earlier. FSG treatment resulted in faster re-epithelialization and reduced wound size at day 14 compared to FBD (50.2% vs. 23.5% and 93.1% vs. 106.7%, p < 0.005, respectively). No differences in TEWL measurements were observed. The FSG integrated into the wound bed quicker as evidenced by lower hydration values at day 21 (309.7 vs. 2500.4 µS, p < 0.05) and higher blood flow at day 14 (4.9 vs. 3.1 fold change increase over normal skin, p < 0.005). Here we show that FSG integrated faster without increased contraction, resulting in quicker wound closure without skin graft application which suggests FSG improved burn wound healing over FBD.

Basic and Experimental Science Cellular-and tissue-based products (CTPs) are used in the treatment of wounds of various etiologies. 1-3 CTPs are typically decellularized and virally inactivated, leaving behind the structural elements of connective tissue, mainly collagens. Most CTPs are composed of type I collagen, but some CTPs also contain other collagen types. One CTP example is porcine urinary bladder matrix that contains numerous collagens. 4 The majority of contemporary CTPs are mammalian in origin. Concerns exist regarding collagen's potential to provoke autoimmune responses. 5-10 In addition to possible autoimmune responses, other disadvantages associated with mammalian-derived matrices are the potential of transmission of prion and viral diseases such as bovine spongiform encephalopathy, 11 as well as cultural and religious objections. 12,13 Fish skin grafts from the Atlantic cod (Gadus morhua) do not pose a risk of disease transmission as do mammalian CTPs. 14 Because of the use of fish skin products in the food industry, there is an abundance of studies on the specific allergens contained in fish skin and on the composition of extracted collagens. 15-17 The introduction of foreign proteins in a test subject can trigger an immune system response that normally results in the transient production of antibodies. The induction of an

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