Her eyes are filled with emotion as Crystal DeVos sees her young daughter Eliana play with the Ariel doll.
“I call her my little mermaid,” DeVos said of her daughter.
Shortly after Eliana was born, it was the healing power of the fish skin that helped her recover from the deep wounds on her neck.
“Eliana doesn’t really think about it,” said DeVos, who lives in Corpus Christi, Texas. “Of course, as she gets older, we want to go back and show her photos and explain what happened because it’s part of her story and is so unique.”
Eliana’s story began about three years ago when she was born about three weeks pregnant and weighed a pound. She spent 131 days in the neonatal intensive care unit, during which she developed a life-threatening infection in her neck, causing severe wounds.
“It almost seemed like a carnivorous illness, and her body was targeting something on her neck,” DeVos said.
As the infection grew, Eliana developed sepsis, an extreme body response to the infection, which closed some of her organs. Every day, DeVos and her family consistently prayed for Eliana to recover.
The medical team then spoke to her about amazing treatment options.
On the 86th day of her NICU stay, Eliana was transferred from her local general hospital to Doriscoll Children’s Hospital in Corpus Christi. She received several medications to treat the infection at both hospitals, including antibiotic therapy. However, it was Driscoll that made the fish skin a new part of her wound care.
“It’s very close to human skin under a microscope, so it helps the wound start to heal,” said Dr Vanessa Dimas, a pediatric plastic surgeon at Drisco who treated Eliana.
When Dimas first met Eliana, she knew she needed to do two things: remove the buildup of dead skin tissue from the wound and cover it with some kind of treatment to help healthy tissue return and grow. However, more traditional approaches such as surgery and human skin grafts have been too dangerous or impossible for preterm babies like Eliana. Her condition was too vulnerable.
“She was premature, the wounds were very widespread and she was quite ill, so I didn’t feel safe doing surgical procedures on her,” Dimas said.
Instead, Dimas and Driscoll’s wound closure nurse practitioners and her colleague Roxana Reyna used medical grade honey solutions to clean the wounds. They then painted the honey mixture with fish skin and fish skin, covering the area.
Fish skin, a medical product made from wild North Atlantic cod and manufactured by Icelandic company Kelesis, provided the type of scaffolding or platform for new skin tissue to grow. Omega oil and some of the other natural elements of fish skin helped to contribute to the healing process, Dimas said, adding that “it’s basically a job and helps heal the wounds and it melts a bit.”
Potential risks of skin treatment for this fish include the reaction of children with fish allergies. In babies, you may not know if they have an allergy or not.
“That’s the biggest risk: it’s an unknown allergy that can cause some issues,” Dimas said. “Otherwise, there’s still a chance that your child will need surgery because you don’t know how much it will help them heal them.”
However, for Eliana, treatment of fish skin appeared to be well tolerated and promote healing.
Fish skin is used to care for wounds around the world, but it remains rare for use in children, not only in young children.
In March, Dimas and Reina presented data on the approach to preterm infants at the European Association for Wound Management in Barcelona, Spain. They spoke about two case studies: Eliana and a severely preterm baby with abdominal wound.
“Eliana weighed three pounds the day I applied my fish skin graft,” Reina said. Other patients weighed 1 pound during treatment.
“Since Eliana, we’ve been able to feel confident enough to use it with even smaller babies,” Reina said.
According to Driscoll Children’s Hospital, Eliana’s care team appears to have first implemented Kelesis fish skin to wound care for a pound of preterm baby.
Reyna and Dimas are recognized for their work, and for the innovative use of the product, Kerecis invited them to share their clinical insights on public forums.
The concept of using fish skin to help heal human damaged tissue has been around for years, but it is still not a common practice, said Dr. Arun Gosain, chair of the Orthopedic Secretary’s Section of Plastic Surgery and Orthopedics at Anne & Robert H. Lurie Children’s Hospital in Chicago.
Depending on the depth and severity of the wound, there are “so many different options” for wound treatment, he said. Some approaches include tissue from other types of animals.
“There are other forms of what we call xenografts. Or we take tissue from another species and use it for wound healing,” said Gosain, who was not involved in Eliana’s case. For example, pig skin is commonly used in wound care, just like cow collagen.
“Xenografts may be possible in the future, but they have not been used for skin replacements. They are currently only used in biological clothing,” he said. Biological dressings help to temporarily cover the wound and support the natural healing process, essentially assisting in healing the wound by itself or preparing for surgical treatment to close it.
For example, those with a “full thickness scar” (those that mean extending to all three layers of skin) mean that they are not healed in themselves.
In that scenario, “I could use pig skin,” he said. “We put it there as a biological dressing and realize that the skin doesn’t regenerate, but we keep the wound clean until we’re ready to somehow transfer the patient’s skin to close the wound, whether it’s a skin graft or something else.”
In their case study, Reina and Dimas described Eliana as having a “full thickness scar”, but after three days of treatment of the fish skin, they described it as “dramatic results”. They continued to change her dressing every three days, and after the wound was cleaned and the dead skin tissue was removed, the first fish skin mixture healed 10 days after adding minimal scarring, according to the study.
“There were no side effects and no additional surgical intervention was required,” they wrote. Three years later, Eliana’s wounds were very faint and almost invisible.
DeVos says she was inspired by watching fish skins promote healing in her daughter’s wounds, and hopes that Eliana’s story will help contribute to her understanding of fish skins as a medical tool.
“What people want to take away is that we can appreciate the power of modern medicine and the faith,” she said.
“Don’t be afraid to try something new. Always open your heart and just have faith,” she said. “If something’s not true or you’ve never been exposed to it before, you’ve got a chance and have a bit of faith. And in our case, it really worked.”
