The Kerecis graft material made from fish skins

Medical Report Details Use of Fish Skin Graft on Combat Burn Injuries During 2020 Karabakh War

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By Lucas Karamanoukian

Special to the Mirror-Spectator

A recent medical report published in the journal Military Medicine  documents the successful use of a novel Fish Skin Graft to treat combatants during the 2020 Karabakh War. Dr. Foaud Reda, the plastic surgeon and lead author of the report, states that the temporary burn dressings were “very much comparable to human skin” in temporizing combat burn injuries.

According to the study authors, the Fish Skin Grafts were provided on an emergency basis by Kerecis, an Icelandic company that originally patented the acellular burn dressing. In conjunction with the Armenian government, Kerecis further deployed two physicians (Dr. Hilmar Kjartans and Dr. Steven Jefferey) to deliver and train Armenian surgeons on the use of the Fish Skin Graft.

The authors described the use of Fish Skin Grafts on three Armenian combatants that were injured as a result of either blast or explosion injuries in Artsakh and transferred for higher level-of-care to hospitals in the Republic of Armenia. The fish-derived skin grafts were used to help cover exposed wounds and temporize wound coverage prior to definitive reconstructive surgery.

The 2020 Nagorno-Karabakh War represented an unprovoked attack on the sovereignty of the Artsakh Republic and the Republic of Armenia by Azerbaijan. With disregard to the peaceful civilian population in Artsakh, Azerbaijan launched an unprecedented military advancement using lethal drone attacks on civilian and military infrastructure along the entire contact-line.

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The ensuing casualties among the Armenian military and civilian population overwhelmed the military field triage units and hospital systems in Artsakh and Armenia.

“In our visits to Artsakh Republic, we found the reconstructive surgeons and trauma units at Stepanakert Hospital to be well-equipped, trained, and extremely capable,” noted U.S. surgeons Drs. Raffy Karamanoukian and Hratch Karamanoukian. “The unfortunate part was that the ferocity of the attacks with white phosphorus agents simply overwhelmed the trauma infrastructure.”

The devastating explosion at the Stepanakert fuel depot on September 25, 2023

Among the three cases presented by the authors, one soldier was documented to have sustained a full body burn caused by white phosphorus exposure.  Evidence collected after de-escalation of the conflict pointed to the indiscriminate use of white phosphorous compounds by Azerbaijan, a chemical compound that can produce debilitating and fatal chemical burns.

Burn injuries were a significant concern during the 2020 Karabakh War, resulting from chemical, thermal, and explosive damage to the skin. Plastic surgeon Dr. Gayane Mkhitaryan, a reconstructive microsurgeon in Armenia, notes that “white phosphorus burns accounted for a large number of casualties in both inpatient and outpatient medical wards in Armenia.”

“Fish Skin Grafts represent a new burn injury resource for deployment in war zones that lack the obligatory requirements of human-derived or pig-skin substitutes,” notes Artsakh plastic surgeon Dr. Igor Zakharyan. Dr. Zakharyan remained Chief of Plastic and Reconstructive Surgery at Central Republic Hospital in Stepanakert throughout the 2020 war.

The use of temporary Fish Skin Grafts in Armenia during the war represents a novel technique for temporary coverage of burn combat injuries. The deployment of the Fish Skin Graft proved effective in stabilizing patients with significant burn injuries until complete reconstruction was scheduled. This technique helps control infection rates in patients waiting for future reconstruction, especially when there is a continuous inflow of combatant injuries.

Based on the observations noted with Fish Skin Graft on combat injuries in Armenia during the 2020 Karabakh War, the authors of the medical report foresee the use of this novel burn wound skin graft among field hospitals in conflict zones throughout the world.

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