In my hospital we have ample experience with another technique using polypropylene sheets for defect coverage, popularized in Brazil orthopedics as "Figueiredo's technique", which is in practice an extension of common techinques for temporary closure of abdominal wall ("Bogota's bag").
We put a transparent polypropylene sheet as skin replacement, suture it directly to the skin. We can monitor the wound and its secretions, can cover exposed tendons and bones without immediate doing microsurgical flaps. For example, we can monitor the second intention skin closure with reduced infection and analgesics use, sometimes without needing a graft at all.
There is an Icelandic company called Kerecis that produces these kinds of fish skin based grafts. There are some videos of some of their patient's before and after over at their webpage[0] but be warned, they might be a bit graphic for some.
I thought this a pretty mature technique? I have seen more than once our local vet using this technique to treat cats with large wounds -- with great results by the way. Interestingly, they too used tilapia fish skin, and not any of the more common local fish species. I wonder if there is something special about tilapia fish skin, or it was simply the species on which the technique was developed, and nobody bothered to try using other fish species.
What's special is that tilapia is probably cheaper than even the local fish since it's farmed in massive quantities and shipped all over the world as food.
If other fish skins were tried it must have been similar results.
>I have seen more than once our local vet using this technique to treat cats with large wounds -- with great results by the way.
I'm not surprised, a lot of vets I know from Iraq and Afghanistan had used Tilapias for battlefield dressing. Worst case there was a Tilapia MRE people kept around for this purpose. Honestly it's great to see them taking those skills from war and translating them into helping street animals such as cats.
I think one of the most interesting techniques for burn victims is using placentas. I haven't seen it too much in my current hospital system, but have seen it talked about at medical association conferences and think it's pretty exciting.
Here is a gift link for an article about them in the New York Times from about a year ago.
The fact that tilapia skin was basically waste, yet turns out to have higher collagen content, better tensile strength, and better moisture retention than human skin is kind of remarkable
My nephew had multiple heart surgery, and after the last one, he kept having the wound release liquids. For months, they just medicated the wound regularly hoping it would solve by itself. At last, they decided for a cleaning surgery, and a pediatric specialist came from Rome and apparently brought something like "fish sheets" to "cover the wound while it heals.
This has been going for long enough that there's been several metastudies debunking it. Was hyped in the news around 2017.
Fish skin or silver sulfadiazine had similar effects and to me are both approximating placebo from the studies I read. The fish does nothing for pain and no difference in the scarring time vs the silver ointments.
fish skin (rich in collagen) sounds like a version of collagen patch. And for collagen patch for example https://pmc.ncbi.nlm.nih.gov/articles/PMC3081477/ where despite the "Conclusion" the "Results" show that it helps (and one can also expect that collagen patching is starting point to engineering artificial skin) :
Results:
With two weeks of treatment, 60% of the ‘collagen group’ wounds and only 42% of the ‘conventional group’ wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of ‘collagen group’ wounds and 48 (80%) of ‘conventional group’ wounds were >75% healed (P=0.21). Eight patients in the ‘collagen group’ and 12 in the ‘conventional group’ needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility.
Conclusion:
No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients’ compliance and comfort.
You made me go re-search for those meta studies and I can only find a brazilian one which disputes the claims but I do find a few showing benefits. I'm back to not knowing what to believe in isolation, but with results also for plasters that you shared I'm more leaning towards you being right. Thanks for sharing.
Totally anecdotal but I had a bad burn on my foot and I thought I could manage it with otc stuff. It kept getting worse so I went to have it checked out and was prescribed the silver cream.
From one day to the next it started showing positive effects and a week and a half later I was fine. I was kicking myself for waiting so long.
tangentially related: before penicillin was formally discovered, soldiers in WW1 would use moldy slices of bread to treat their wounds (Penicillium being the most common bread mold). This or similar practices of using mold on wounds seems to date back thousands of years
In Chinese villages, I've seen them use fish skin, potato skin, various leaves, cooked birds nest, fish fin oil, and etc to treat open wounds instead of pure bandaging.
While it's not a new technique, it's fascinating for this area to be further explored.
It's important in these cases to preserve the lineage of where they came from.
There's a tendency to start calling them 'western medicine' and crediting it to the person who formalized it in the west rather than the source culture where it has existed for centuries.
The conversation is bit 2010, but the point still stands.
It's old news. There is even “And Dream of Sheep” — Grey’s Anatomy, Season 15 Episode 17.
That’s the episode where they mention using tilapia fish skin to treat burns.
Original U.S. air date: March 14, 2019.
Doesn't make it any less interesting. And in spite of it not being new, it doesn't look like it's out of the experimental stage: the article mentions it's difficult to get the tilapia skin processed and sterilized.
Hmm, I remember seeing something like this mentioned in the show The Good Doctor. I forget the episode, but it deals with a patient who suffers severe burns in a bus crash and receives an experimental treatment using fish skin to aid in healing and minimize scarring. I never really felt comfortable with animal tissue being grafted to human skin. I don't believe animal tissue can be totally cleansed of contaminants. I'd rather feel more confortable with synthetic skin grafting. The movie, Darkman (1990) comes to mind.
How expensive is the sterilization process, though? That would be my primary concern if tilapia-skin bandages started to get widely available/mass-produced: that unscrupulous vendors would cut corners during sterilization, and then the burn victims would get nasty infections from remnant bacteria on the tilapia skin.
I think any farmed animal is or should have no waste. Even if it’s turned into cat food the skin is most definitely not just waste, there’s uses out there. However, if it is as cheap and readily available as cat food then that’s great for burn victims too.
> In the US, animal-based skin substitutes require levels of scrutiny from the Food and Drug Administration and animal rights groups that can drive up costs, Lee said. Given the substantial supply of donated human skin, tilapia skin is unlikely to arrive at American hospitals anytime soon.
This reminds me of Milton Friedman’s arguments against the FDA.
I wonder what’s the difference between countries that drives that. It’s not like Brazil doesn’t have its own FDA, which is much more strict than the US one, from what I know. Maybe some kind of lobbying? Or are animal rights group that much stronger?
I was having a conversation about this with my father-a retired pharmaceutical industry executive-a few weeks back, about why certain generic prescription medication formulations were unavailable in Australia yet sold in New Zealand. He explained to me that the Australian pharmaceutical regulator (the TGA) and its New Zealand equivalent (Medsafe) had very different regulatory philosophies. Medsafe, if a major international regulator (such as the US FDA or the EU’s EMA) had already approved something, they’ll just approve it too (“if it is good enough for them it is good enough for us”); the TGA’s attitude was very different, just because the FDA or EMA had approved it didn’t mean they automatically would, they wanted to analyse the safety data for themselves and make up their own mind. For blockbuster patented drugs, the extra regulatory cost of Australia was worth it, but for the long tail of miscellaneous generic formulations, the extra cost of dealing with the TGA could make some of them financially nonviable.
> But Brazil lacks the human skin, pig skin, and artificial alternatives that are widely available in the US.
This is not an improvement on existing methods (it may end up being, but that is not the motivation) but rather a case of it being all they have to work with.
Tilapia skin is probably better than no skin at all.
> It’s not like Brazil doesn’t have its own FDA, which is much more strict than the US one, from what I know.
Unless we are talking about pesticides, where Brazil is effectively dumping grounds for substances banned in EU. Every time some pesticide is forbidden in Europe, brazilian regulators are happy allowing local agribusiness import it by the ton in fire sales: https://www.brasildefato.com.br/2025/10/14/export-grade-pois...
No, I'm saying I think it's even farther back than that. I think the article from 2017 is like the article from today. It's presenting something old as something novel.
This is quite old news. I've heard about this more than 10 years ago at least.
It has been fairly successful since the beginning and I've heard it improved quite a lot
In my hospital we have ample experience with another technique using polypropylene sheets for defect coverage, popularized in Brazil orthopedics as "Figueiredo's technique", which is in practice an extension of common techinques for temporary closure of abdominal wall ("Bogota's bag").
We put a transparent polypropylene sheet as skin replacement, suture it directly to the skin. We can monitor the wound and its secretions, can cover exposed tendons and bones without immediate doing microsurgical flaps. For example, we can monitor the second intention skin closure with reduced infection and analgesics use, sometimes without needing a graft at all.
I was informed by a pediatric doctor they also use honey bandages for burns since it is a naturally antimicrobial and assists with cooling the body.
Modern medicine is pretty metal.
There is an Icelandic company called Kerecis that produces these kinds of fish skin based grafts. There are some videos of some of their patient's before and after over at their webpage[0] but be warned, they might be a bit graphic for some.
[0]: https://kerecis.com
Wow, those before and after videos really are amazing - while my own scars are tiny, they aremore noticeable than some of these fairly major wounds.
I thought this a pretty mature technique? I have seen more than once our local vet using this technique to treat cats with large wounds -- with great results by the way. Interestingly, they too used tilapia fish skin, and not any of the more common local fish species. I wonder if there is something special about tilapia fish skin, or it was simply the species on which the technique was developed, and nobody bothered to try using other fish species.
> I thought this a pretty mature technique? […]
Yes, it is very mature. The article was written in 2017.
Tilapia are cheap and abundant, and the skin is an industrial-scale waste product.
They're incredibly hardy, and unlike most other food fish you can easily grow them in simple container setups.
Horrible to talk about a living creature this way.
4 replies →
What's special is that tilapia is probably cheaper than even the local fish since it's farmed in massive quantities and shipped all over the world as food.
If other fish skins were tried it must have been similar results.
Tilapia imports are heavily restricted to Australia, The live fish will not be allowed, they are considered "restricted noxious fish".
The rules are:
Illegal to Keep: You cannot keep tilapia (dead or alive), sell them, give them away, or use them as bait.
Immediate Euthanasia: Humanely kill the fish as soon as you catch it.
Disposal:
Bury: Bury them deep and well away from the water's edge to prevent scavengers from dragging them back in or floodwaters from releasing eggs.
Bin: Place them in a rubbish bin.
No Filleting: You cannot take fillets and dispose of the rest; the entire fish must be destroyed.
Various state departments have hotlines for reporting tilapia.
There are different hotlines per state:
Queensland Department of Agriculture and Fisheries (DAF) (13 25 23)
New South Wales Department of Primary Industries (DPI) (1800 675 888)
Victoria (VFA) Reporting hotline (13FISH or 13 34 74)
Western Australia Dept. of Primary Industries & Regional Development (1800 815 507)
I've had rewards for reporting them (fishing reel, free bait, etc).
4 replies →
No need for antibiotics because the fish got ample amounts while growing up in the farm.
It's probably a mix of "this species happens to be unusually well-suited" and "this is the species people bothered to study rigorously first."
>I have seen more than once our local vet using this technique to treat cats with large wounds -- with great results by the way.
I'm not surprised, a lot of vets I know from Iraq and Afghanistan had used Tilapias for battlefield dressing. Worst case there was a Tilapia MRE people kept around for this purpose. Honestly it's great to see them taking those skills from war and translating them into helping street animals such as cats.
They used this exact treatment in an episode of The Good Doctor, S01E06. Original air date: October 30, 2017
https://the-good-doctor.fandom.com/wiki/Not_Fake
Yes, but the treatment has been devised way prior to 2017.
They also used it in Grey's Anatomy S15E17 (2019).
I was thinking same, Jared saving that girls skin after burn.
I think one of the most interesting techniques for burn victims is using placentas. I haven't seen it too much in my current hospital system, but have seen it talked about at medical association conferences and think it's pretty exciting.
Here is a gift link for an article about them in the New York Times from about a year ago.
https://www.nytimes.com/2024/10/08/well/placenta-donations-b...
This article is from 2017 - maybe should say so in the submission title?
Still, an interesting read
Added above. Thanks!
The fact that tilapia skin was basically waste, yet turns out to have higher collagen content, better tensile strength, and better moisture retention than human skin is kind of remarkable
My nephew had multiple heart surgery, and after the last one, he kept having the wound release liquids. For months, they just medicated the wound regularly hoping it would solve by itself. At last, they decided for a cleaning surgery, and a pediatric specialist came from Rome and apparently brought something like "fish sheets" to "cover the wound while it heals.
This has been going for long enough that there's been several metastudies debunking it. Was hyped in the news around 2017.
Fish skin or silver sulfadiazine had similar effects and to me are both approximating placebo from the studies I read. The fish does nothing for pain and no difference in the scarring time vs the silver ointments.
fish skin (rich in collagen) sounds like a version of collagen patch. And for collagen patch for example https://pmc.ncbi.nlm.nih.gov/articles/PMC3081477/ where despite the "Conclusion" the "Results" show that it helps (and one can also expect that collagen patching is starting point to engineering artificial skin) :
Results:
With two weeks of treatment, 60% of the ‘collagen group’ wounds and only 42% of the ‘conventional group’ wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of ‘collagen group’ wounds and 48 (80%) of ‘conventional group’ wounds were >75% healed (P=0.21). Eight patients in the ‘collagen group’ and 12 in the ‘conventional group’ needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility.
Conclusion:
No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients’ compliance and comfort.
You made me go re-search for those meta studies and I can only find a brazilian one which disputes the claims but I do find a few showing benefits. I'm back to not knowing what to believe in isolation, but with results also for plasters that you shared I'm more leaning towards you being right. Thanks for sharing.
Totally anecdotal but I had a bad burn on my foot and I thought I could manage it with otc stuff. It kept getting worse so I went to have it checked out and was prescribed the silver cream.
From one day to the next it started showing positive effects and a week and a half later I was fine. I was kicking myself for waiting so long.
tangentially related: before penicillin was formally discovered, soldiers in WW1 would use moldy slices of bread to treat their wounds (Penicillium being the most common bread mold). This or similar practices of using mold on wounds seems to date back thousands of years
previously:
https://news.ycombinator.com/item?id=14385336
In Chinese villages, I've seen them use fish skin, potato skin, various leaves, cooked birds nest, fish fin oil, and etc to treat open wounds instead of pure bandaging.
While it's not a new technique, it's fascinating for this area to be further explored.
In a way this feels less like inventing something new and more like rediscovering and formalizing old techniques with modern safety constraints
It's important in these cases to preserve the lineage of where they came from.
There's a tendency to start calling them 'western medicine' and crediting it to the person who formalized it in the west rather than the source culture where it has existed for centuries.
The conversation is bit 2010, but the point still stands.
It's old news. There is even “And Dream of Sheep” — Grey’s Anatomy, Season 15 Episode 17. That’s the episode where they mention using tilapia fish skin to treat burns. Original U.S. air date: March 14, 2019.
Doesn't make it any less interesting. And in spite of it not being new, it doesn't look like it's out of the experimental stage: the article mentions it's difficult to get the tilapia skin processed and sterilized.
The article is 9 years old so that may no longer be the case
Old news comes off dismissive. Doesn’t have to be a brand new discovery to be noteworthy.
2019? I'm surprised they kept it running for that long.
It's still running - season 22 right now.
And a 2017 Good Doctor episode
They did this in the Netflix One Piece series (with a yellowtail though)
Hmm, I remember seeing something like this mentioned in the show The Good Doctor. I forget the episode, but it deals with a patient who suffers severe burns in a bus crash and receives an experimental treatment using fish skin to aid in healing and minimize scarring. I never really felt comfortable with animal tissue being grafted to human skin. I don't believe animal tissue can be totally cleansed of contaminants. I'd rather feel more confortable with synthetic skin grafting. The movie, Darkman (1990) comes to mind.
I hope they verify that the recipients are not allergic to fish first. Would be nice to get a synthetic version for that reason.
TLDR;
Its a fantastic substitute for bandages in the sense that you don't need to take off the fish skin everyday.
Its also better are retaining moisture in the burn wounds than cotton badages.
No need for antibiotics, painkillers etc
Its also really cheap. Fish farms regard them as waste.
> Fish farms regard them as waste.
I have only seen tilapia sold whole - the skin is one of the best parts when you fry them.
Same here. Not with just tilapia, but pretty much every fish.
How expensive is the sterilization process, though? That would be my primary concern if tilapia-skin bandages started to get widely available/mass-produced: that unscrupulous vendors would cut corners during sterilization, and then the burn victims would get nasty infections from remnant bacteria on the tilapia skin.
Dunno what method they use, but gamma irradiation is pretty cheap at scale
I think any farmed animal is or should have no waste. Even if it’s turned into cat food the skin is most definitely not just waste, there’s uses out there. However, if it is as cheap and readily available as cat food then that’s great for burn victims too.
> In the US, animal-based skin substitutes require levels of scrutiny from the Food and Drug Administration and animal rights groups that can drive up costs, Lee said. Given the substantial supply of donated human skin, tilapia skin is unlikely to arrive at American hospitals anytime soon.
This reminds me of Milton Friedman’s arguments against the FDA.
I wonder what’s the difference between countries that drives that. It’s not like Brazil doesn’t have its own FDA, which is much more strict than the US one, from what I know. Maybe some kind of lobbying? Or are animal rights group that much stronger?
I was having a conversation about this with my father-a retired pharmaceutical industry executive-a few weeks back, about why certain generic prescription medication formulations were unavailable in Australia yet sold in New Zealand. He explained to me that the Australian pharmaceutical regulator (the TGA) and its New Zealand equivalent (Medsafe) had very different regulatory philosophies. Medsafe, if a major international regulator (such as the US FDA or the EU’s EMA) had already approved something, they’ll just approve it too (“if it is good enough for them it is good enough for us”); the TGA’s attitude was very different, just because the FDA or EMA had approved it didn’t mean they automatically would, they wanted to analyse the safety data for themselves and make up their own mind. For blockbuster patented drugs, the extra regulatory cost of Australia was worth it, but for the long tail of miscellaneous generic formulations, the extra cost of dealing with the TGA could make some of them financially nonviable.
3 replies →
I imagine it is about this:
> But Brazil lacks the human skin, pig skin, and artificial alternatives that are widely available in the US.
This is not an improvement on existing methods (it may end up being, but that is not the motivation) but rather a case of it being all they have to work with.
Tilapia skin is probably better than no skin at all.
3 replies →
> It’s not like Brazil doesn’t have its own FDA, which is much more strict than the US one, from what I know.
Unless we are talking about pesticides, where Brazil is effectively dumping grounds for substances banned in EU. Every time some pesticide is forbidden in Europe, brazilian regulators are happy allowing local agribusiness import it by the ton in fire sales: https://www.brasildefato.com.br/2025/10/14/export-grade-pois...
(2017)
Is this a stem cell thing or a growth factor/morphogens thing?
They do this in Iceland too
> Mar 3, 2017
Title needs (2017)
great news for humans, bad news for fish
I've read Dune - I know exactly where this is going. Please do not apply sand trout directly to you skin unless you are ready to control the spice.
The God Emperor of Brazil would be a brilliant satire. I look forward to the new fish speakers.
The power to destroy a thing is the absolute control over it.
[dead]
i saw that episode of one-piece
Will never be approved by the US FDA since it can't be patented.
Kerecis got FDA clearance in 2013, and then approval in 2016.
That's made from cod, and it appears they chemically modified it so that it can be patented https://www.kerecis.com/kerecis-receives-u-s-patent-for-fish...
You mean because nobody will pay the cost to go through FDA process without profit incentive?
I'm pretty sure they've done this for decades. I seem to remember someone using potato skins like 30 years ago.
> I'm pretty sure they've done this for decades […]
Yes, the article you read is from 2017.
No, I'm saying I think it's even farther back than that. I think the article from 2017 is like the article from today. It's presenting something old as something novel.
This is quite old news. I've heard about this more than 10 years ago at least. It has been fairly successful since the beginning and I've heard it improved quite a lot