Outcomes of Apert Syndrome Hand Reconstruction With Tilapia Skin: A Prospective Study.

BACKGROUND: Tilapia skin has already been used in various medical scenarios, but there are no studies showing the use of tilapia skin for hand reconstruction in Apert syndrome. The objective of this study is to determine whether the use of tilapia skin during graft bed preparation for children with Apert syndrome can shorten wound reepithelialization intervals, reduce the number of dressing changes, and decrease patient discomfort. METHODS: This is a prospective study on consecutive patients with Apert syndrome who underwent hand reconstruction at our Hospital. Patients were divided into 2 groups: (1) a control group consisting of patients who underwent conventional digit separation hand reconstruction surgery (2) an experimental group consisting of patients who underwent similar digit separation hand reconstruction surgery that commenced with the placement of a thin layer of tilapia skin at the raw commissures during a first operation, which was subsequently replaced by an autologous skin graft during a second operation staged 10 days postoperatively. Pain assessment was performed using the Visual Analog Scale. The number of dressing changes was also assessed. A T test compared the total number of dressings changes and pain data. RESULTS: Experimental group patients (n = 8) required an average of 9.4 days of daily dressing changes, and control group patients (n = 5) required an average of 20.8 days of daily dressing changes ( P < 0.05) and tended to experience significantly less pain when compared with patients in the control group ( P = 0.079). CONCLUSION: Tilapia skin can shorten wound reepithelialization intervals by reducing the total number of dressing changes.

Neovaginoplasty With Nile Tilapia Skin: Cytological and Microbiota Evaluation.

OBJECTIVES: To study the clinical, cytological, and vaginal microbiota findings in patients with Mayer-Rokitansky-Küster-Hauser syndrome who underwent neovaginoplasty using Nile tilapia fish skin. METHODS: This is a cross-sectional study with 7 cisgender women with Mayer-Rokitansky-Küster-Hauser syndrome who had previously undergone neovagina reconstruction using Nile tilapia fish skin at a university hospital. Local institutional review board approval and written permission from the patient were obtained. Between August 2019 and November 2021, within 12 to 24 months after surgery, vaginal specimens were obtained for conventional oncotic and hormonal cytology, and for Gram staining. The Nugent scores were calculated. Colposcopy was also performed. RESULTS: Squamous cells without atypia were found in all patients. Five patients had intermediate vaginal microbiota (Nugent score of 4), which was determined by the presence of few lactobacilli on Gram staining. In hormonal cytology, 4 patients presented with findings compatible with menacme. No colposcopic change was observed. When postsurgical dilation was performed correctly, a mean vaginal length of 8.3 cm was maintained after 1 year of follow-up. CONCLUSIONS: Squamous cells without atypia were present in neovaginas with Nile tilapia fish skin. Most vaginal contents revealed intermediate microbiota and hormonal results compatible with menacme. Studies with a greater number of patients are necessary for a more comprehensive understanding of the microbiome in neovaginas with this new technique, thereby providing support for the treatment and prevention of associated pathologies.

Linha do tempo da pele de tilápia (Oreochromis niloticus) na medicina regenerativa moderna: Da bancada ao paciente / Timeline of tilapia skin (Oreochromis niloticus) in modern regenerative medicine: From bench to patient

OBJETIVO: Descrever a trajetória de desenvolvimento dos curativos biológicos oriundos de pele de tilápia (Oreochromis niloticus) em glicerol e liofilizada para uso em cirurgias externas e, posteriormente, uma matriz proteica acelular (scaffold) para uso interno. RESULTADOS: A pele de tilapia no glicerol e liofilizada foi aplicada com sucesso em mais de 550 pacientes queimados. A pele de tilápia liofilizada obteve sucesso no tratamento de 53 mulheres em vaginoplastias, em 160 pacientes na redesignação sexual e na preparação do leito da ferida na autoenxertia em 15 portadores da Síndrome de Apert. O scaffold está sendo empregado na oftalmologia na medicina veterinária na reconstrução de córnea em 420 cães, nas duroplastias na neurocirurgia nos testes em animais, e em estudos para uso cirúrgico em 10 especialidades médicas. CONCLUSÕES: O curativo de pele de tilápia supera desafios do tratamento de queimados do Brasil. É barato, biossustentável, efetivo e reduz a dor do paciente, propiciando melhores resultados com potencial redução de custos, contribuindo para a qualidade de vida dos pacientes. O sucesso da pesquisa confirma a pele de tilápia como um novo biomaterial de grande potencial em medicina regenerativa.

OBJECTIVE: To describe the development trajectory of biological dressings made from tilapia (Oreochromis niloticus) skin in glycerol and freeze-dried for use in external surgeries and, subsequently, an acellular protein matrix (scaffold) for internal use. RESULTS: Tilapia skin in glycerol and freeze-dried was successfully applied to more than 550 burn patients. Freeze-dried tilapia skin was successful in the treatment of 53 women undergoing vaginoplasty, in 160 patients in sexual reassignment and in preparing the wound bed in self-grafting in 15 patients with Apert Syndrome. The scaffold is being used in ophthalmology, veterinary medicine in corneal reconstruction in 420 dogs, in duraplasty in neurosurgery in animal tests, and in studies for surgical use in 10 medical specialties. CONCLUSIONS: The tilapia skin dressing overcomes challenges in treating burns in Brazil. It is cheap, biosustainable, effective and reduces patient pain, providing better results with potential cost reduction, contributing to patients' quality of life. The success of the research confirms tilapia skin as a new biomaterial with great potential in regenerative medicine.

Desenvolvimento de uma matriz acelular de pele tilápia para tratamento de feridas: Um estudo experimental / Development of acellular tilapia skin matrix for wound treatment: An experimental study

OBJETIVO: Produzir um scaffold baseado em matriz extracelular (SMEC) biocompatível, atóxico e estéril, para tratamento de queimaduras e feridas. Explorou-se a utilização da pele de tilápia como alternativa, ressaltando suas propriedades semelhantes à pele humana e sua aplicação bem-sucedida em diferentes áreas médicas. MÉTODO: Descreve o processo de preparação dos SMEC de pele de tilápia, incluindo etapas de desengorduramento, descontaminação, descelularização e irradiação por raios gama a 25kGy para esterilização. São realizados testes laboratoriais para avaliar a toxicidade celular in vitro pelo método do MTT, análises histológicas com coloração de hematoxilina-eosina, análises microbiológicas e de quantificação de DNA. RESULTADOS: Destacam que os SMEC produzidos foram descelularizados de maneira eficaz, preservando a matriz extracelular e mostrando-se não citotóxicos. Além disso, a análise microbiológica evidenciou a esterilidade dos materiais após a irradiação, comprovando sua adequação para aplicação clínica. A quantificação de DNA revelou a efetividade da descelularização, reduzindo significativamente o conteúdo de DNA original do tecido. CONCLUSÕES: Foi possível o desenvolvimento de uma matriz oriunda da pele de tilápia, sendo ela não citotóxica, estéril, portadora de morfologia adequada para aplicação clínica e acelular. Assim, contribuindo para inovação da ciência brasileira.

OBJECTIVE: To produce a biocompatible, non-toxic, and sterile scaffold based on extracellular matrix (ECM) for the treatment of burns and wounds. The utilization of tilapia skin was explored as an alternative, highlighting its similar properties to human skin and its successful application in different medical areas. METHODS: The process of preparing tilapia skin-derived ECM scaffolds is described, including steps of degreasing, decontamination, decellularization, and gamma ray irradiation at 25kGy for sterilization. Laboratory tests were conducted to assess in vitro cellular toxicity using the MTT method, histological analyses with hematoxylin-eosin staining, microbiological analyses, and DNA quantification. RESULTS: It is emphasized that the produced ECM scaffolds were effectively decellularized, preserving the extracellular matrix and demonstrating non-cytotoxicity. Furthermore, microbiological analysis evidenced the sterility of the materials after irradiation, confirming their suitability for clinical application. DNA quantification revealed the effectiveness of decellularization, significantly reducing the original DNA content of the tissue. CONCLUSIONS: The development of a tilapia skin-derived matrix was achieved, which is non-cytotoxic, sterile, possesses suitable morphology for clinical application, and is acellular. Thus, contributing to the innovation of Brazilian science.

Nile tilapia skin (Oreochromis niloticus) for burn treatment: ultrastructural analysis and quantitative assessment of collagen.

Nile tilapia (Oreochromis niloticus) skin is a well-known biomaterial used as an occlusive dressing for burn treatment. It is also an inexpensive and important source of collagen. This study aims to describe the ultrastructural aspects of Nile tilapia skin, assess its collagen amount and organization, and compare quantitative methods of histochemical and immunohistochemical analysis (in all sterilization steps for use in burn dressings). One sample (0.5 × 0.5 cm) of ten different fish skins was divided in four groups: in natura skin (IN), chemical sterilization (CH), additional irradiation (30 kGy) (IR), and skins used in burn treatment (BT) to compare histochemical and immunohistochemical findings of collagen amount and describe ultrastructural aspects through scanning electron microscopy. The amount of type I collagen decreased during sterilization and clinical use owing to gradual reduction of immunostaining (anti-collagen-I) and decreasing fiber thickness of the collagen, when compared to type III (Picrosirius-red-polarized light). The collagen fibers were rearranged at each sterilization step, with a low collagen percentage and large structural disorganization in BT. The amount of type-I collagen was further reduced after BT (p < 0.05). Both the methods did not exhibit a quantified value difference (p = 0.247), and a positive correlation (r = 0.927; 95 % CI = 0.720-0.983) was observed between them, with concordance for collagen quantification in similar samples, presenting a low systematic error rate (Dalberg coefficient: 6.70). A significant amount of type-I collagen is still observed despite sterilization, although clinical application further reduces type I collagen. Its quantification can be performed both by immunohistochemistry and/or Picrosirius Red reliably.

Nile Tilapia Fish Skin-Based Wound Dressing Improves Pain and Treatment-Related Costs of Superficial Partial-Thickness Burns: A Phase III Randomized Controlled Trial.

BACKGROUND: In a phase II study comparing Nile tilapia fish skin to silver sulfadiazine cream for outpatient management of superficial partial-thickness burns, the fish skin decreased reepithelialization time (average reduction, 1.43 days), dressing changes (average reduction, 3.72 dressings), and visual analogue scale pain scores. The present study aimed to further evaluate Nile tilapia fish skin efficacy for superficial partial-thickness burns. Unlike silver sulfadiazine cream, the fish skin has good adherence to the wound bed, which may prevent infections and decrease need for dressing changes. Thus, it could be a low-cost alternative to hasten healing and improve pain of burn patients. METHODS: A phase III randomized controlled trial was conducted from April of 2017 to October of 2018 in Fortaleza, Brazil, and included 115 outpatients aged 18 to 70 years with superficial partial-thickness burns affecting 15 percent or less of body surface area and no previous treatment. Fifty-seven patients were treated with the glycerolized fish skin and 58 with silver sulfadiazine cream 1%. Primary outcomes were reepithelialization time, number of dressings, treatment-related costs, and pain intensity, assessed by means of visual analogue scale, Electronic von Frey, Burns Specific Pain Anxiety Scale, and analgesic use. Patients were evaluated every 48 hours. RESULTS: Patients treated with fish skin required fewer days for reepithelialization (9.7 ± 0.6 days versus 10.2 ± 0.9 days; p = 0.001) and fewer dressings (1.6 ± 0.7 versus 4.9 ± 0.5; p < 0.001). They also had decreased analgesic needs and visual analogue scale, Burns Specific Pain Anxiety Scale, and Electronic von Frey measurements. Finally, fish skin use reduced the final average treatment-related cost per patient by 42.1 percent. CONCLUSION: By hastening reepithelialization, improving burn-related pain, and decreasing treatment-related costs, Nile tilapia fish skin could benefit the resource-poor public health systems of developing countries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

A Randomized Comparison Study of Lyophilized Nile Tilapia Skin and Silver-Impregnated Sodium Carboxymethylcellulose for the Treatment of Superficial Partial-Thickness Burns.

Glycerolized Nile tilapia skin (NTS) showed promising results when used for burn treatment in phases II and III randomized controlled trials. This pilot study aims to evaluate the effectiveness of lyophilized NTS (LNTS) as a temporary skin substitute for superficial partial-thickness burns by comparing it with silver-impregnated sodium carboxymethylcellulose dressing. This was a randomized, prospective, open-label, and controlled pilot study conducted in Fortaleza, Brazil, from April 2019 to December 2019. The 24 participants had ≥18 and ≤70 years of age and superficial partial-thickness burns affecting up to 10% of TBSA. Primary outcomes were the number of dressings performed and pain intensity, assessed via the Visual Analogue Scale and the Electronic von Frey. Secondary outcomes were the level of pain-related anxiety, assessed via the Burns Specific Pain Anxiety Scale, and analgesic consumption. In the test group, the number of dressings and the patient-reported pain after dressing-related procedures were lower. Analgesic intake, pain-related anxiety, and both patient-reported and objectively measured pain before dressing-related procedures were similar for the treatment groups. No adverse effects were detected. LNTS shares the same characteristics of an "'ideal'" wound dressing demonstrated by glycerolized NTS in previous studies. Also, it demonstrated noninferiority for burn management when compared with silver-impregnated sodium carboxymethylcellulose dressing. The safety and efficacy of LNTS demonstrated in this pilot study may allow the development of larger phases II and III RCTs in a near future.

Tratamento de queimaduras de segundo grau profundo em abdômen, coxas e genitália: uso da pele de tilápia como um xenoenxerto / Treatment of deep second-degree burns on the abdomen, thighs, and genitalia: use of tilapia skin as a xenograft

A pele de tilápia possui microbiota não infecciosa e estrutura morfológica semelhante à pele humana. Estudos clínicos fase II, ainda não publicados, mostraram resultados promissores na sua utilização para tratamento de queimaduras. Nos protocolos destes estudos, pacientes com lesões em áreas de dobras de pele, como genitais e região inguinal, foram excluídos, pois achava-se que o biomaterial não aderiria apropriadamente, resultando em um grau de cicatrização inferior. Relato de caso de paciente do sexo feminino, 18 anos, sem comorbidades, com queimaduras de segundo grau profundo em abdômen, região inguinal, parte da genitália e metade superior de ambas as coxas, envolvendo 13,5% da área total da superfície corporal. A pele de tilápia foi aplicada nas lesões levando a uma reepitelização completa com 16 dias de tratamento. Não foram observados efeitos colaterais. A pele de tilápia traz, portanto, a promessa de um produto inovador, de fácil aplicação e alta disponibilidade, que pode se tornar a primeira pele animal nacionalmente estudada e registrada pela Agência Nacional de Vigilância Sanitária, para uso no tratamento de queimaduras. Este relato de caso contribui para reduzir as limitações em relação às áreas anatômicas apropriadas para a aplicação da pele de tilápia, uma vez que, mesmo com a necessidade de reposição de pele, foram obtidos bons resultados com aplicação na genitália e região inguinal.

Tilapia skin has a non-infectious microbiota and a morphological structure similar to human skin. Phase II clinical studies, not yet published, have shown promising results in their use for the treatment of burns. In the protocols of these studies, patients with lesions in areas of skin folds, such as genitals and inguinal regions, were excluded, as it was thought that the biomaterial would not adhere properly, resulting in a lower degree of healing. Case report of a female patient, 18 years old, without comorbidities, with deep second-degree burns in the abdomen, inguinal region, part of the genitalia and upper half of both thighs, involving 13.5% of the total body surface area. Tilapia skin was applied to the lesions leading to a complete re-epithelialization with 16 days of treatment. No side effects were observed. Tilapia skin, therefore, brings the promise of an innovative product, easy to apply, and highly available, which can become the first animal skin nationally studied and registered by the Agência Nacional de Vigilância Sanitária, for use in the treatment of burns. This case report contributes to reduce the limitations concerning the anatomical areas appropriate for the application of tilapia skin, since, even with the need for skin replacement, good results were obtained with application to the genitalia and inguinal region.

Concurrent validity of electronic von Frey as an assessment tool for burn associated pain.

An important challenge in pain assessment is the inability of an evaluator to corroborate, using objective signs or indicators, the subjective pain report of a patient. In this scenario, the Electronic von Frey (EVF) anaesthesiometer rises as a valuable Quantitative Sensory Testing modality for pain evaluation. Although EVF showed good reproducibility when applied to healthy areas in humans, its use for evaluation of burn-related pain threshold has not yet been validated. The present study demonstrated the concurrent validity of EVF by determining its correlation with the traditionally used Visual Analog Scale (VAS). EVF was compared to VAS through pain measurements obtained from 44 patients with superficial partial thickness burns treated with silver sulfadiazine. A very good and significant positive correlation between both methods was detected. Baseline clinical and demographic parameters did not significantly affect the association between EVF and VAS. Additionally, EVF had significant and moderate positive correlation with the amount of analgesic used and with the Burns Specific Pain Anxiety Scale scores. Regular pain assessment is essential for the establishment of an appropriate treatment plan; thus, it is critical that we continue to refine our pain assessment skills to avoid chronic pain and psychological trauma in burn patients.

Male-to-Female Gender-Affirming Surgery Using Nile Tilapia Fish Skin as a Biocompatible Graft.

STUDY OBJECTIVE: Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth. DESIGN: Stepwise demonstration of the procedure with narrated video footage. SETTING: Transgender health clinic. INTERVENTIONS: A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period. CONCLUSION: Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.

Innovative Burn Treatment Using Tilapia Skin as a Xenograft: A Phase II Randomized Controlled Trial.

Skin substitutes are considered a useful alternative for occlusive dressings in the treatment of superficial burns as they reduce the frequency of dressing replacement. This phase II randomized controlled trial aimed to evaluate the efficacy of Nile tilapia (Oreochromis niloticus) skin as an occlusive xenograft dressing for the treatment of burn wounds in humans. In order to assess the use of tilapia skin, the following variables were evaluated: number of days for wound healing, the number of times the occlusive dressing was changed, use of anesthetics or analgesics, pain assessment using the Visual Analogue Scale, and evaluation of burn improvement on the day of dressing removal. In total, 62 participants completed the study. It was found that in participants treated with tilapia skin, complete reepithelialization occurred in significantly fewer days; reported pain intensity was lower (study arms B and C), the amount of anesthetics/analgesics required was lower (study arms B and C), and the necessity of dressing changes was significantly reduced in comparison with volunteers treated with silver sulfadiazine. In our study, the tilapia skin xenograft showed good efficacy as an occlusive biological dressing for burn wound treatment in humans.

Neovaginoplasty Using Nile Tilapia Fish Skin as a New Biologic Graft in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome.

Mayer-Rokitansky-Küster-Hauser syndrome is the second most common cause of primary amenorrhea, trailing only to gonadal dysgenesis. Neovaginoplasty is an appropriate treatment option for patients who have failed dilation therapy. Several biomaterials have been used in this procedure, including peritoneum, amnion, skin grafts, and myocutaneous flaps. Nile Tilapia Fish Skin has noninfectious microbiota, morphologic structure comparable to human skin, and high in vivo bioresorption. In addition, it showed good outcomes when used as a xenograft for burn treatment. Thus, we suggest it as a new biologic graft for vaginal agenesis management. In this descriptive study, neovaginoplasty using Nile Tilapia Fish Skin offered 3 patients an anatomic and functional neovagina via a simple method with potential long-term effectiveness. When postsurgical dilation was performed correctly, a vaginal length greater than 6 cm was maintained at 180 days follow-up. Histologic and immunohistochemical analyses revealed the presence of stratified squamous epithelium with high expression of cytokeratins and fibroblast growth factor, matching the characteristics of normal adult vaginal tissue. We believe that further studies will show Nile Tilapia Fish Skin to be a relevant option in the therapeutic arsenal of Mayer-Rokitansky-Küster-Hauser syndrome.

Pediatric Burn Treatment Using Tilapia Skin as a Xenograft for Superficial Partial-Thickness Wounds: A Pilot Study.

This study aims to evaluate the efficacy of Nile tilapia skin as a xenograft for the treatment of partial-thickness burn wounds in children. This is an open-label, monocentric, randomized phase II pilot study conducted in Fortaleza, Brazil. The study population consisted of 30 children between the ages of 2 and 12 years with superficial "partial-thickness" burns admitted less than 72 hours from the thermal injury. In the test group, the tilapia skin was applied. In the control group, a thin layer of silver sulfadiazine cream 1% was applied. Tilapia skin showed good adherence to the wound bed, reducing the number of dressing changes required, the amount of anesthetics used, and providing benefits for the patients and also for healthcare professionals, by reducing the overall work load. The number of days to complete burn wound healing, the total amount of analgesics required throughout the treatment, burn improvement on the day of dressing removal, and pain throughout the treatment were similar to the conventional treatment with silver sulfadiazine. Thus, tilapia skin can be considered an effective and low-cost extra resource in the therapeutic arsenal of pediatric superficial partial thickness burns.

Uso da pele de tilápia do Nilo em medicina regenerativa: Status atual e perspectivas futuras / Nile tilapia fish skin use in regenerative medicine: Current status and future perspectives

OBJETIVO: O presente estudo tem como objetivo apresentar a trajetória do desenvolvimento da pele de tilápia como curativo biológico. MÉTODO: Descrição do processo de desenvolvimento da pele de tilápia como curativo biológico, desde a concepção da ideia para utilização no tratamento de queimaduras, até as perspectivas de sua utilização como scaffold em múltiplas especialidades médicas. RESULTADOS: Com o objetivo de oferecer uma alternativa segura, eficaz e de baixo custo para o tratamento de queimaduras, pesquisadores brasileiros desenvolveram um curativo biológico derivado da pele de tilápia. CONCLUSÃO: A pele de tilápia vem demonstrando um notável potencial como curativo biológico no tratamento de queimaduras e na medicina regenerativa.

OBJECTIVE: The present study aims to present the development trajectory of the tilapia skin as a biological dressing. METHODS: To describe the development process of tilapia skin as biological dressing, from the conception to the burn wounds treatment to the perspectives of its use as a scaffold in multiple medical specialties. RESULTS: In order to provide a safe, effective and low-cost alternative for the treatment of burn injuries, Brazilian researchers have recently developed a biological dressing derived from tilapia skin. CONCLUSION: The tilapia skin have been demonstrating the remarkable potential as a biological dressing in burn injuries treatment and in regenerative medicine.

Neovaginoplasty for radiation-induced vaginal stenosis using Nile Tilapia Fish Skin as a biological graft.

Tilapia skin showed good results when used as a biological graft for surgical management of Mayer-Rokitansky-Küster-Hauser syndrome. Thus, our researchers considered the use of this biomaterial for neovaginoplasty in radiation-induced vaginal stenosis. We report the case of a 41-year-old female patient with a total occlusion of the vaginal canal after radiotherapy for vaginal cancer. McIndoe neovaginoplasty using tilapia skin as a scaffold for proliferation of new vaginal epithelium was performed. Initially, laparoscopic dissection of the rectovaginal septum and vesicovaginal space spaces was conducted. In the vaginal surgical time, a transverse transmural incision was made in the scarred vaginal reminiscent followed by blunt dissection and insertion of an acrylic mold covered with tilapia skin. Good anatomical and functional outcomes were noted. Vaginal reconstruction with tilapia skin seems to be an excellent option for patients with radiation-induced vaginal stenosis due to its wide availability, easy application and high effectiveness.

Elaboração, desenvolvimento e instalação do primeiro banco de pele animal no Brasil para o tratamento de queimaduras e feridas / Elaboration, development, and installation of the first animal skin bank in Brazil for the treatment of burns and wounds

Introdução: A produção e a distribuição de pele humana pelos Bancos de Pele do Brasil é insuficiente para atender a demanda do país, suprindo menos de 1% da necessidade para tratar as vítimas de queimaduras. O objetivo do trabalho foi apresentar a elaboração e o desenvolvimento da implantação do primeiro Banco de Pele Animal do Brasil para tratamento da queimadura. Métodos: Trata-se de um estudo metodológico. O Banco de Pele Animal Aquático foi elaborado, desenvolvido e instalado a partir do desenvolvimento do processamento de pele da tilápia, da revisão sistemática de estudos referentes a banco de pele animal, de visitas à pscicultura em Jaguaribara-CE, da visita técnica aos bancos de pele humana no Brasil, de consulta técnica e de treinamento no Banco de Pele de Recife, da observação de todas as fases de processamento da pele de tilápia e da identificação da estrutura física da área onde ocorrem todos os processos. Resultados: Além da produção e da distribuição da pele da tilápia para os estudos em vítima de queimaduras, o banco está processando mais de 5000 peles de tilápia e encontra-se em fase de distribuição desta pele para estudos multicêntricos em outros estados e outras especialidades, que desenvolvem pesquisas nas áreas de ginecologia, ortopedia, endoscopia, estomaterapia, cirurgia vascular, odontologia e veterinária. Conclusão: este trabalho possibilitou a elaboração, o desenvolvimento e a implementação do primeiro Banco de Pele Animal do país e o primeiro Banco de Pele Aquática do mundo.

Introduction: The production and distribution of human skin by Brazilian skin banks is insufficient to meet the country's demand, supplying less than 1% of the need for treating burn victims. The objective of this work was to present the elaboration and development of the first animal skin bank of Brazil for the treatment of burns. Methods: This methodological study elaborated, developed, and installed The Aquatic Animal Skin Bank in terms of the development of tilapia skin processing after a systematic review of studies referring to animal skin banks based on visits to the pisciculture center in Jaguaribara-CE, technical visits to human skin banks in Brazil, technical consultation and training in the Recife Skin Bank, the observation of all phases of tilapia skin processing, and the identification of the physical structure of the area where the processes occur. Results: In addition to the production and distribution of tilapia skin for studies on burn victims, the bank is processing more than 5000 tilapia skin samples and is in the distribution phase of this skin for multicentric studies in other states and specialties including gynecology, orthopedics, endoscopy, stomatherapy, vascular surgery, dentistry, and veterinary medicine. Conclusion: This work enabled the elaboration, development, and implementation of Brazil's first animal skin bank and the world's first aquatic skin bank.

Innovative treatment using tilapia skin as a xenograft for partial thickness burns after a gunpowder explosion.

Tilapia skin has non-infectious microbiota, high amounts of type I collagen, and similar morphological structure to human skin, so it has been suggested as a potential xenograft for the management of burn wounds. A 23-year-old male patient, with no comorbidities, arrived at our burn treatment center after a thermal injury caused by contact with flames from a gunpowder explosion. Superficial partial thickness burns were present in his right upper limb and deep partial thickness burns were present in his left upper limb. Tilapia skin was applied to the lesions, leading to complete reepithelialization within 12 and 17 days of treatment, respectively. No dressing changes were needed and no side effects were observed. Tilapia skin carries the promise of an innovative, easy-to-apply and highly available product that can become the first nationally studied animal skin registered by the National Sanitary Surveillance Agency for use in the treatment of burns.

Use of Tilapia Skin as a Xenograft for Pediatric Burn Treatment: A Case Report.

Burns represent the fifth most common cause of nonfatal childhood injuries in the world. The Nile tilapia skin (Oreochromis niloticus) is widely available in Brazil and demonstrated, in previous studies, noninfectious microbiota, morphological structure similar to that of human skin, and good outcomes when used as a xenograft for treatment of experimental burns in rats. A 3-year-old boy was admitted to a burn treatment center in Fortaleza, Brazil, with scalds in the left side of the face, neck, anterior thorax, abdomen, and left arm. Involvement of 18% of total body surface area with superficial partial thickness burns was calculated. After local Institutional Review Board approval and written permission from the patient's legal caregiver were obtained, application of tilapia skin as an occlusive dressing was performed. Good adherence of tilapia skin to the wound bed was detected. The patient was discharged from the hospital with a total of 10 days required for the complete re-epithelialization of his superficial partial thickness burn. No adverse effects were noted. We believe that further studies conducted by our researchers will allow this innovative, low-cost, widely available and easy to apply biomaterial to firm itself as a relevant option in the therapeutic arsenal of pediatric burns, producing significant social and financial impact for the health system.

Tilapia fish skin as a new biologic graft for neovaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome: a video case report.

OBJECTIVE: To describe a McIndoe procedure technique for surgical management of Mayer-Rokitansky-Kuster-Hauser syndrome with the use of Nile tilapia skin as a scaffold for the proliferation of new vaginal epithelium. DESIGN: Surgical video article. Local Institutional Review Board approval and written permission from the patient were obtained. There were no conflicts of interest. SETTING: University hospital. PATIENT(S): A 17-year-old woman who presented at our gynecology department with the complaint of primary amenorrhea. At physical examination, she had a phenotypically normal vulva with no vaginal canal. Magnetic resonance imaging of the abdomen and pelvis revealed normal ovaries and absence of uterus and vaginal canal. No other congenital malformations were found. Karyotype was 46,XX. INTERVENTION(S): The McIndoe procedure involved only a vaginal approach. Labia minora were separated, and a transverse midline incision of 3 cm was made. The vesicorectal space was progressively dissected. Blunt dissection was performed initially with digital separation of tissues. The neovagina was then inspected with the introduction of a vaginal speculum, allowing for review of hemostasis. Blunt dissection was continued with the aid of the speculum, to reach the appropriate vaginal dimensions. Subsequently, a vaginal acrylic mold covered with two pieces of processed and sterilized tilapia fish skin was inserted and accommodated into the newly created cavity. The external side of the tilapia skin, which maintained its grayish coloration after the removal of the scales, stayed in contact with the acrylic mold, while the white internal side of the tilapia skin, which was previously attached to the fish's muscle, stayed in contact with the walls of the neocavity. The mold was held in position by four multifilament polyglactin 1.0 sutures in the labia majora, thus preventing expulsion. MAIN OUTCOME MEASURE(S): Anatomic data, such as measurement of the final canal length, and histomorphologic analysis, 180 days after surgery. RESULT(S): The patient remained on bed rest for 9 days, after which the tilapia fish skin had been partially reabsorbed. After this time, the acrylic mold was removed. A larger plastic mold was then inserted and the patient was advised to wear it day and night for the first postoperative month. The vaginal mold had to be worn each night until normal sexual intercourse was possible. The final canal length 180 days after surgery was between 8 and 9 cm. For the histopathologic analysis, fragments of the lateral vaginal wall were removed 180 days after surgery and showed the presence of stratified squamous epithelium with five cell layers, ectasic blood vessels, and occasional desquamated epithelial cells. CONCLUSION(S): The procedure described offered this patient an anatomic and functional neovagina by means of a simple, safe, easy, effective, quick, and minimally invasive procedure. Limitations include the experimental nature of this study, based on a single case report with no long-term outcome results. The tilapia fish skin is a low-cost and widely available biomaterial.

Elaboração de um protocolo para implementação e funcionamento do primeiro banco de pele animal do Brasil: Relato de experiência / Preparation of a protocol for the implementation and functioning of the first animal skin bank of Brazil: Experience report / Elaboración de un protocolo para implementación y funcionamiento del primer banco de piel animal de Brasil: Relato de experiencia

Objetivo: Elaborar um protocolo para implementação e funcionamento do primeiro banco de pele animal do Brasil. Resultados: Para a construção do protocolo, até o presente momento, foram realizadas as seguintes etapas: visita técnica ao Banco de Pele Animal de Recife, onde foi traçado o levantamento das necessidades de insumos, controle de esterilização e organização do ambiente; identificação e descrição de todas as etapas do processamento da pele de tilápia; elaboração de planilhas de relação de materiais necessários para o processamento da pele de tilápia; e controle do gasto de material utilizado. Conclusão: Frente à incontestável importância e ineditismo da concepção do primeiro Banco de Pele Animal do Brasil e o primeiro para pele de animal aquática no mundo, o papel do enfermeiro é fundamental para a elaboração e implantação de um protocolo que, por meio de um gerenciamento adequado, assegure o estabelecimento de regras, uniformização dos procedimentos e rotinas de processo. Este trabalho permitirá a criação de manuais e controles que irão nortear os processos e garantir a qualidade de todas as etapas do processamento da pele da tilápia do primeiro Banco de Pele Animal do Brasil.

Objective: Elaboration of a protocol for the implementation and operation of the first animal skin bank in Brazil. Results: For development of the protocol, until now, the following steps were taken: technical visit to Recife Skin Bank and consulting the head nurse, where it was traced the supplies needs assessment, sterilization control and environmental organization; identification and description of all stages of tilapia skin processing; elaboration of spreadsheets regarding a list of materials necessary for the processing of tilapia skin and control of the expenditure of the material employed. Conclusion: Before of the undeniable importance and the conception originality of the first Animal Skin Bank of Brazil and the first for aquatic animal skin in the world, the role of a nurse becomes key piece to design and implement a protocol that, through adequate management, ensure the establishment of rules, standardization of procedures and process routines. This work will allow the creation of manuals and controls that will guide the processes and guarantee the quality of all stages of the skin processing of tilapia of the first Animal Skin Bank of Brazil.

Objetivo: Elaborar un protocolo para la implementación y el funcionamiento del primer banco de piel animal de Brasil. Resultados: Para el desarrollo del protocolo, hasta el presente momento, se realizaron las siguientes etapas: visita técnica al Banco de Piel de Recife y consultoría por la enfermera jefe, donde fue trazado el levantamiento de las necesidades de insumos, control de esterilización y organización del ambiente identificación y descripción de todas las etapas del procesamiento de la piel de tilapia; elaboración de planillas de relación de materiales necesarios para el procesamiento de la piel de tilapia y control del gasto de material utilizado. Conclusión: El papel del enfermero es fundamental, para la elaboración e implantación de un protocolo que, a través de una gestión adecuada, asegure el establecimiento de reglas, uniformidad de los procedimientos y rutinas de proceso. Este trabajo permitirá la creación de manuales y controles para orientar los procesos y garantizar la calidad de todas las etapas del procesamiento de la piel de la tilapia del Primer Banco de Piel Animal de Brasil.