A fishy fix for wounds that flounder

 

They say time heals all wounds. This can be true for many ailments, be they physical or spiritual. But for Hal Miller, time alone was not enough to bring his 306-day wound to a close. Though he never expected that fish skin would become a vital part of his recovery, when his care team at The Parkview Centers for Wound Healing in Kendallville suggested it, he was willing to try anything to get back to living as fully as possible.

Against the current

Hal's upstream paddle began when he was diagnosed with idiopathic pulmonary fibrosis, a chronic progressive lung condition characterized by thickening lung tissue. Over time, this scarring inhibits the lung's ability to transfer oxygen to the blood, making it increasingly difficult to breathe.

"My right lung was no good, and the right diaphragm was no good," Hal said. "Finally, I met with a transplant team in Indianapolis, and they accepted me."

On August 16, 2022, Hal underwent a bilateral lung transplant. While the procedure itself was successful, complications arose in the months that followed. In early 2023, Hal developed an infection in his upper chest, requiring additional surgery to remove the infected tissue and a wound vacuum to aid healing and keep the infection at bay. Despite these efforts, the wound was still not closing.

"Normally, I heal really well, but the medications I'm on make for a slower recovery," Hal said, referring to the immunosuppressant medications that he must take indefinitely to prevent his body from rejecting his transplanted organs.

By the time Janalynn Miller, NP, PPG - Wound Care, first assessed Hal's wound in January 2024, it had stalled completely and was not healing. "Unfortunately, Hal did have a few setbacks along the way," Janalynn recalled. " His muscle and his bone were exposed, and the bone was infected, which is called osteomyelitis."

The initial methods for healing Hal's wound began with negative pressure wound treatment, a vacuum-assisted closure therapy that uses suction to promote healing. Subsequent methods included:

• Calcium alginate to absorb drainage

• Collagen applications to support cell growth

• Hypochlorous acid wash to fight and reduce bacteria growth

• Hyperbaric oxygen therapy to help with chronic refractory osteomyelitis

In addition to administering advanced wound techniques externally, the Wound Care team also used holistic approaches, focusing on the nutritional aspects of recovery. Hal was encouraged to follow a high-protein diet and prescribed special dietary drinks to supplement his care. "Our team of nurses, technicians and providers were constantly thinking about what we could do to help our patient get back to his normal life," Janalynn said. "We pulled out almost every treatment we have in our toolbox."

Running out of options, Janalynn suggested fish skin grafts, a technique she'd only used with another patient once before Hal but remembered positive results. Knowing Hal's love for the outdoors, she believed he'd embrace the unconventional tactic. 

"She said, 'I'd like to try something on you,' and it was the fish skin. I'd never heard of such a thing, but she thought that it was going to help me. So, I said, 'I'm in,'" Hal recalled. 

 

Cue the cod-fetti

In most applications, skin grafts are sourced from another location of the patient's body to cover an injury or incision where there is not enough skin available for normal healing. However, in circumstances like Hal's, animal tissue, often from a pig, can be used to promote cell growth and tissue regeneration.

Applying the fish skin graft involves cleaning and debriding (removing dead, damaged or infected tissue). Then, a skin barrier is placed around the wound to ensure the dressing adheres. Unlike other grafts made in a sheet or mesh-like material, the Kerecis® MariGen Micro™ is a micronized fish skin with a texture similar to confetti. It is mixed with saline, allowing it to mold into complex shapes for difficult-to-reach wounds. Once placed on the wound, it is covered with a dressing for a week and then changed at the next appointment.

Hal received his first fish skin graft application on October 2, 2024. At the time, his wound measured 1.6 centimeters long, 4 centimeters wide and 2 centimeters deep at approximately 85% closed. When he returned for the next application, Janalynn found the difference in size astounding. Hal's wound had shrunk to nearly half its size after only a week of treatment. By the sixth treatment, his incision had reached 94.85% closure, measuring 1 centimeter long, 2.5 centimeters wide and 0.7 centimeters deep.

"The wound starting out was practically a seven to eight-inch gap, and it's come down to about a pencil head. I've been X-rayed since, and there's no more infection," Hal said. 
 

Making waves

Inspired by Hal's experience, Janalynn submitted his case study to the 2025 Kerecis Aurora Awards Northern Lights Wound Workshop hosted in Reykjavik, Iceland.

"When I received the email announcing I had received an international award, I was dumbfounded. I couldn't believe this had just happened. Only three nurse practitioners were selected, and the rest were surgeons," Janalynn said.

While honored to have her work recognized, she credits Hal's progress to the entire wound care team. "We all work together, from the front desk to our patient care tech and nurses. It wasn't just one of us who helped Hal; it was all of us together," she said.

Reflecting on his experience, Hal expressed immense appreciation for all the caregivers and providers who have supported him along the way. "I don't know of one person in this whole deal that I did not like. My care was beyond excellent. Janalynn and the other girls have been very good to me and made sure I understood everything going on with my lung or wound."

Although his journey has been long, and he is still adapting to some limitations, Hal feels fortunate and is excited for the second chance that his new lungs and healing wound will provide. "Since the surgery, my oldest granddaughter has had a baby, and he's 14 months now. I may have never gotten to see that little guy," he said. "I've been feeling pretty good, and I'm getting stronger. I went snowmobiling last weekend. I didn't do a lot; I just took baby steps and went through the trails with some friends and my brother. I signed back up for my golf league, and I'm looking forward to that as well."

 

Learn more

Healing acute and chronic wounds requires proper care and attention. The Parkview Centers for Wound Healing are focused on helping you recover so you can get back to the things you enjoy. Outpatient wound clinics do not require a physician referral. If you are dealing with a chronic wound or need additional information and support, contact any of our three locations for help.