Pierre Jahn G.

Tayaban BSCHE-4A

A Report on the Medical Application of Tilapia Skin as a Xenograft for Skin Burns

Burns are a common type of injury that can result in serious skin wounds and
infection, disability, and even death. Each year, nearly 180,000 people die because of burn
injuries according to the World Health Organization. Whereas over ten million people suffer
severe burns and require medical attention. Usually, skin burns are treated through
medication and proper care, on the other hand serious burns are subjected to skin grafting
which is expensive but effective.

Skin grafts that are taken from the patient’s own skin is called autograft and it’s
considered as a limited treatment due to its limited source, whereas skin obtained from
another human is called allograft and it is expensive. As such, in consideration of the
availability and cheapness of material, researchers came up with processed tissue sourced
from animals as an alternative. This is called xenograft, the transfer of processed tissue from
animals to humans.

Tilapia skin application as a xenograft material started in Fortaleza, Brazil, a

developing country in South Africa. Due to lack of attention towards organ donation
programs in this country, many burn victims do not receive skin grafts or must pay exorbitant
fees to obtain a donor graft. As such, researchers at the Federal University of Ceará turned
their attention on xenograft. They utilized tilapia skin since the fish is widely grown
throughout Brazil, and the skin is a waste product that is typically discarded.

Fish skin has a high concentration of Omega-3 fatty acids which have antibacterial
and antiviral properties. It has wide range of amino acids which stimulate cell and tissue
regeneration, reduce inflammation, fight bacteria, and protect nerve endings. It contains
special healing peptides (tilapia piscidin-3 or TP3) that accelerate cell proliferation
and remodeling. As a wound dressing, it is effective since it adheres firmly to the wound and
holds moisture efficiently. Tilapia skin in particular has non-infectious microbiota, high
levels of type I and type III collagen that promotes wound healing, and a morphology similar
to human skin, making it an ideal xenograft for skin burns.

The researchers used the tilapia skin to treat a 23 year old Brazilian man who had
burn wounds due to a gunpowder explosion. According to the report, there were superficial
partial thickness burns (SPTB) in the right upper limb and deep partial thickness burns
(DPTB) in the left upper limb of the patient. It was calculated that 16% of his total body
surface was burned using the Lund and Browder chart. After admission in the treatment
Pierre Jahn G. Tayaban BSCHE-4A

center, the patient was resuscitated using Parkland formula and was stabilized. Since it was
the first xenograft using tilapia skin, the approval of the Local Institution Review Board was
obtained together with the consent of the patient. According to the Journal of Surgical Case
Reports (2019), the Nile tilapia fish skin (NTFS) was subjected to a rigorous process of
chemical sterilization, glycerolization, and irradiation, followed by microbiological tests for
bacteria and fungi, before being stored in a refrigerated sterile packaging. The skin was
washed in sterile 0.9% saline for 5 minutes three times in a row prior to grafting. Lima and
his colleagues (2016), as cited in the aforementioned journal, demonstrated that the
biomaterial showed no change in its microscopic and tensiometric structure after treatment,
and that it recovered its natural consistency after rehydration.

The patient was first anesthetized followed by the cleaning of lesion and removal of
necrotic and fibrinous tissues. The fish skins were applied directly on the burn wounds with 1
cm minimum coverage of healthy skin in the wound borders to ensure that any area of the
burn is not exposed upon movement in the first few days of treatment. Also, superposition of
at least 1 cm between NTFS pieces were made. Finally, the wounds were tightly wrapped in
gauze and bandaged. Blood samples were collected on a daily basis, but no significant
changes were discovered. In addition, the patient's vital signs and clinical status remained
stable. For the first week of treatment, gauze and bandages were removed every 72 hours to
assess NTFS adherence. The biomaterial adhered well to the wound and did not require
dressing changes. On the 12th day of treatment, NTFS had a dried and hardened appearance
and started to slough off from the patient’s limb. Thus, the researchers decided to remove
NTFS in the area by showering and soaking the wound with water. The hydration process led
to weakening, breaking, and slippage of the NTFS thus exposing the underlying healed skin.

The researchers who first proposed Tilapia fish skin as a possible treatment for burn
wounds recently published the findings of a clinical trial involving 115 burn victims in
Brazil. The Phase III results which were published in the journal "Plastic and Reconstructive
Surgery" demonstrated that using fish skin for burns was effective in a way that healing
process sped up, frequency of changing wound dressing lessened, pain is reduced together
with the need for painkillers, and lastly costs of treatment significantly decreased.
Pierre Jahn G. Tayaban BSCHE-4A

References

Alimoradi, M. (2021). Fish skin for burn wounds: the future wound dressing? Retrieved from

https://myacare.com/blog/fish-skin-for-burn-wounds-the-future-wound-dressing

Anderson, L. (2021). The difference between an autograft, allograft, and xenograft. Retrieved

from https://www.andersonperiodontal.com/the-difference-between-an-autograft-

allograft-and-xenograft/

Ibrahim, A., Soliman, M., Kotb, S., & Ali, M. (2020). Evaluation of fish skin as a biological

dressing for metacarpal wounds in donkeys.  https://doi.org/10.1186/s12917-020-

02693-w

Lima-Junior E.M., de Moraes Filho M.O., Costa B.A., Fechine F.V., de Moraes M.E., Silva-

Junior F.R., Soares M.F., Rocha M.B., & Leontsinis C.M. (2019). Innovative

treatment using tilapia skin as a xenograft for partial thickness burns after a

gunpowder explosion. https://doi: 10.1093/jscr/rjz181

UVA Health (2022). Skin graft. Retrieved from https://uvahealth.com/services/plastic-

surgery/skin-graft