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Page 10 of 14 Pignet et al. Plast Aesthet Res 2024;11:40 https://dx.doi.org/10.20517/2347-9264.2024.54

favorable characteristics for use in a front-line environment, including low weight, ease of transport,
ruggedness, and easy handling. The authors noted that provided with sterile conditions for debridement,
sterile saline solution, and room temperature dry storage, Kerecis® Omega3 Wound Matrix can easily be
[20]
utilized .

Smolle et al. reported on a 17-year-old female injured by a landmine in the War in Ukraine with mostly
deep dermal to full-thickness burns of a TBSA of 17 % and associated acute kidney injury (acute kidney
injury I stage 3) on continuous hemodialysis, with prior craniotomy and intracerebral shrapnel removal in
[25]
Ukraine and a longitudinal tracheal rupture . The patient was transferred to the author’s institution 13
days after trauma . With the remaining burn wounds already partially covered by STSG 19 days after
[25]
injury, wounds of the epifascially debrided right upper extremity were still coated by a meaningful amount
of debris and therefore debrided and treated with NPWT. Wound swabs of the right arm revealed multi-
resistant gram-negative (4MRGN) Acinetobacter baumannii, 4MRGN Pseudomonas aeruginosa, Fusarium
species, and mold fungus . The empiric antimicrobial therapy of voriconazole, linezolid, and meropenem
[25]
was swapped for a focused regimen consisting of polymyxin B, cefiderocol, and isavuconazole. 26 days after
injury, the wounds of the right upper extremity, despite improvement, continued to lack conditions suitable
for skin grafting and still tested positive for 4MRGN Pseudomonas aeruginosa. To facilitate wound
[25]
conditioning and suppress wound colonization, Kerecis® Omega3 Wound Matrix was applied . Six days
after application, the wounds showed sufficient granulation and were able to be covered using split-
[25]
thickness skin grafts, with a subsequent excellent graft take . The authors argued that the omega-3 fatty
[25]
acids contained in Kerecis® Omega3 Wound Matrix possess anti-inflammatory and antiseptic qualities .
Both studies report promising findings on the use of Kerecis® Omega3 Wound Matrix in conflict areas or
with victims of armed conflict, but lack any kind of control group. While their findings seem to be
supported by literature, further clinical trials in the field are necessary. It is worth noting that while many of
today’s conflicts take place in low- and middle-income countries, Kerecis® Omega3 Wound Matrix is still
associated with a high cost, possibly rendering the product prohibitively expensive for many regions in war.
However, Kerecis® claims to donate some of their product to victims of conflict and natural disasters (https:/
/www.kerecis.com/charitable-use/).

Yoon et al. presented a case of a 52-year-old female with full-thickness contact burn wounds and exposed
adipose tissue on her left thigh . Five days after surgery, Kerecis® Omega3 Wound Matrix was applied to
[6]
the wound in combination with NPWT. By the 13th and 14th postoperative day, plentiful granulation tissue
was observed. In further consequence, the wound was suitable for STSG .
[6]

FSGs accelerate healing in acute full-thickness wounds
When it comes to acute wounds, a distinction needs to be made between simple wounds, which are limited
to the superficial dermis, and complex wounds, which also affect deeper tissue structures such as fascia,
[40]
muscle, tendon or bone and create significant deficits in contour and/or function . Complex soft tissue
wounds often demand extensive reconstructive procedures involving pedicled or free flaps . Skin
[41]
substitutes promoting regeneration and new tissue formation could potentially allow for a step-down in the
reconstructive ladder in certain cases. One clinical study investigated the regenerative potential of Kerecis®
Omega3 Wound Matrix in acute full-thickness wounds.

Kirsner et al. reported on a prospective, double-blinded RCT comparing the usage of Kerecis® Omega3
Wound Matrix and dehydrated human amnion/chorion membrane allograft (dHACM) (EpiFix® MiMedx
[11]
Group Inc.) on acute full-thickness defects measuring 4 mm in diameter in otherwise healthy individuals .
They defined the primary endpoint as time to full epithelialization at set fixed time points and the secondary