Integrating Intact Fish Skin Grafts With Muscle and Fasciocutaneous Flaps to Optimize Wound Coverage and Eliminate Secondary Donor Sites: A Single-surgeon Experience.

Background: In complex soft tissue reconstruction, pedicled muscle and fasciocutaneous flaps continue to serve as fundamental techniques. Nevertheless, flap insufficiency, stemming from limited reach, tension, or insufficient bulk, frequently requires secondary flap or grafting procedures, resulting in additional donor site morbidity. This study evaluates the intraoperative application of intact fish skin grafts (IFSGs) as a biological scaffold to assist with wound closure and achieve complete wound coverage without the need for additional donor sites. Methods: A retrospective case series involving 11 patients who underwent soft tissue reconstruction using muscle (n = 3) or fasciocutaneous (n = 8) flaps integrated with IFSG was conducted by a single plastic surgeon. The application of IFSG was performed intraoperatively when the flap volume or reach proved inadequate. Clinical outcomes, healing timelines, and the necessity for reoperation were systematically evaluated. Results: Indications for reconstruction included exposed joints, hardware, bone, tendons without paratenon, and aesthetically critical facial defects. All flaps survived, and IFSGs demonstrated full integration. Ten of 11 wounds achieved complete closure without further surgery. The remaining case, complicated by severe lymphedema, achieved flap survival and coverage of the intended exposed bone but did not go on to fully heal. No secondary tissue harvests were required. The mean healing time was 66.6 days. Conclusions: Intraoperative IFSG integration demonstrates the potential to enhance the functional coverage and healing potential of pedicled muscle and fasciocutaneous flaps, eliminating the need for secondary grafting, and warrants further study.