Successful Limb Salvage Using Staged Applications of a Fish-Skin Xenograft (Kerecis) in a Heel Pad Degloving Injury: A Case Report.

INTRODUCTION: Heel pad degloving injuries represent one of the most challenging problems in lower-extremity reconstruction because durable soft-tissue coverage must withstand repetitive weight-bearing while minimizing infection, wound breakdown, and limb loss. CASE REPORT: We report the use of staged fish-skin xenograft reconstruction as a limb-salvage strategy in a 24-year-old man who sustained a severe heel pad avulsion with multiple open fractures of the foot and ankle following an all-terrain vehicle accident. Initial management consisted of serial irrigation and debridement, fracture stabilization, and negative-pressure wound therapy; however, progressive heel pad necrosis resulted in a 22 × 15 × 0.5 cm full-thickness plantar soft-tissue defect extending to the calcaneus despite aggressive wound management. The patient was subsequently counseled regarding below-knee amputation due to the severity of soft-tissue loss but elected to pursue limb salvage following multidisciplinary discussion of reconstructive options. Three sequential applications of a fish-skin acellular dermal matrix (Kerecis) were performed over 8 weeks, resulting in progressive granulation tissue formation and development of a robust, well-vascularized wound bed suitable for definitive reconstruction. Subsequent full-thickness skin grafting to the heel and split-thickness skin grafting to the surrounding soft-tissue defects achieved complete wound closure without infection, graft loss, or wound breakdown. Hypertrophic scarring and contracture that developed during follow-up were successfully treated with fractional carbon dioxide laser therapy. At 1-year follow-up, the reconstructed heel remained completely healed without recurrent ulceration or infection, demonstrating durable soft-tissue coverage capable of tolerating the biomechanical demands of a weight-bearing plantar surface. CONCLUSION: This case demonstrates the potential role of staged fish-skin xenograft application as a biologically active reconstructive adjunct for wound-bed preparation and limb salvage in complex heel pad degloving injuries. In situations where immediate flap reconstruction is undesirable, and limb salvage remains the patient's goal, staged xenograft reconstruction may expand the reconstructive armamentarium while preserving ambulatory function.