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Pignet et al. Plast Aesthet Res 2024;11:40 https://dx.doi.org/10.20517/2347-9264.2024.54 Page 9 of 14

reported by Badois et al. Despite not yielding statistical significance, donor sites dressed with the standard of
treatment (fatty gauze) healed remarkably slower (67.9 ± 66.2 days) than the Kerecis® Omega3 Wound
[24]
Matrix -treated (31.5 ± 24.7 days) donor sites .The time until re-epithelialization (over 95% of wound area)
was assessed for donor sites treated with Kerecis® Omega3 Wound Matrix, ProHeal® Collagen Wound
Dressing and those left untreated . The inter-group differences were less drastic than in the above-
[6]
mentioned studies. Nonetheless, Kerecis® Omega3 Wound Matrix-treated donor sites still healed faster by
four days compared to ProHeal® Collagen Wound Dressing. The average wound healing time using Kerecis®
Omega3 Wound Matrix was 9.1 ± 1.0 days, compared to 11.9 ± 1.4 days with no wound treatment and 13.1 ±
1.4 days using ProHeal® Collagen Wound Dressing (P < 0.001, respectively) .
[6]

Reduction in pain intensity
Two clinical studies investigated pain intensity at the donor site after the application of Kerecis® Omega3
Wound Matrix [15,24] . Alam et al. investigated pain levels using the Verbal Rating Scale (VRS) with a scale
between 0 and 10. The authors reported an average pain score of 2.3 (1-4 range) after seven days of product
use . Badois et al. compared the pain intensity using the VAS (scale 0-10) five days after surgery between
[15]
Kerecis® Omega3 Wound Matrix and fatty gauze (control group). In the control group, 40% of patients
claimed a VAS score ≥ 3, which represents the threshold for clinically relevant pain [24,39] . That was not the
case in the Kerecis® Omega3 Wound Matrix-treated group, where no patient reported a VAS score of ≥ 3
[24]
after the fifth day post-surgery . This emphasizes and supports the positive effect of FSGs on pain
management. The underlying mechanism of action for pain relief is not yet entirely understood.

No evidence of infections at donor sites
Alam et al. and Badois et al. observed no signs of infection at donor sites treated with Kerecis® Omega3
[24]
Wound Matrix [15,24] . In contrast, 60% of the patients dressed with fatty gauze did show signs of infection .

Fish skin promotes regeneration and reduces microbial burden in combat injuries and full-thickness
burns
The conditions on and around a battlefield present a unique set of challenges for wound treatment.
Limitations in logistics and supply, lacking facilities, and a high case rate are some of the factors favoring
less-than-optimal treatment, with the injuries themselves often presenting as complicated, affecting deep
tissues, covering a large surface area, and necessitating adequate early care to expedite recovery and reduce
the risk of serious infection [20,25] . Civilian casualties have more and more emerged as major victims in war. In
World War I, the rate of nonmilitant casualties reached approximately 20%, with the estimated rate in
recent conflicts around 80% . A good product should have the following qualities: help condition wounds
[25]
currently unfit for coverage; help stabilize wounds that are fit for coverage but cannot currently be covered;
help reduce or prevent wound infection. Two studies were identified focusing on the treatment of combat
injuries and/or full-thickness burns [20,25] .

Reda et al. described a case series and reported on the forward deployment of Kerecis® Omega3 Wound
Matrix in the setting of the 2020 Nagorno-Karabakh War, with the primary goal of using Kerecis® Omega3
Wound Matrix in war victims where skin grafting required prior wound stabilization and conditioning .
[20]
Secondary goals included reduced healing time, reduced time to skin grafting, and improved aesthetic
results . Wounds included expansive full-thickness burns and blast wounds, predominantly treated 3 to 5
[20]
days post injury. The wounds received additional debridement where needed, followed by Kerecis® Omega3
Wound Matrix and negative pressure wound therapy (NPWT) application . The formation of granulation
[20]
tissue several days to weeks earlier was described in all cases treated with Kerecis® Omega3 Wound Matrix,
as well as an absolute lack of infection, enabling a step down in the reconstructive ladder and earlier skin
grafting. However, this study lacked a control group . Kerecis® Omega3 Wound Matrix was able to provide
[20]