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.
A female Atlantic mackerel typically lays between 200,000 and 450,000 eggs during a spawning season. However, larger, healthier individuals can sometimes produce up to a million eggs, often in multiple batches over several weeks.
it is the mackerel themselves who consider baby mackerel lives to be industrial in scale. they produce that many in anticipation of consumption. Each foodfish humans consume has already slaughtered untold thousands of other fish to grow themselves to size.
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.
For those that don't know why, and I didn't, the reason for this is that Tilapia are "mouth brooders", that is they keep the fertilised eggs in their mouth. So throwing away a dead female can cause these eggs to hatch, and reinfect the waters with new Tilapia.
I also hear you can dispose of them by placing them in a pan with fresh pulverized tomato, garlic, olive oil, basil, then a little lemon juice, oregano then finally, salt and pepper to taste. Highly effective, efficient and delicious.
>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.
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
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.
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.
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.
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
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.
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.
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.
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.
> 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.
I would think for a country like Australia a more moderate approach would be to approve things that were approved by other countries and have been in use for some amount of time - say, 5 years or so - apart from the things they directly approve.
The actual drug my father and I were discussing was clonidine.
In the UK and New Zealand, they sell 25 microgram clonidine tablets; in Australia, the smallest dose on sale is 100 micrograms.
Clonidine is a very old drug – it was released back in the 1960s. The risks involved are very well understood (arguably the biggest risk is fatal overdoses, but patient/parent education is the accepted mitigation strategy.)
The issue is, in Australia, it is only approved for treating high blood pressure in adults. Paediatricians and child psychiatrists commonly prescribe it for ADHD, and for anxiety, aggression and insomnia (particularly but not exclusively in the context of ASD); in adults, it is prescribed to treat menopausal hot flushes and migraines – but all those indications are off-label.
And this is the problem – given the doses involved, 25 microgram tablets only really make sense for those off-label indications, there isn't much demand for them for treating adult hypertension. So to get the TGA to approve 25 microgram clonidine tablets, you need to prove to them that clonidine is safe and effective for one of those currently off-label indications. And that will cost a lot of money, and given it is a generic medication long out of patent protection, it isn't worthwhile. Whereas Medsafe quite possibly just decided "the UK approved it for X so we will too".
As a parent, both of whose children are prescribed clonidine, this annoys me – cutting tablets in half is no fun, and cutting them into quarters is even worse. Or I can get them compounded into liquid by a compounding pharmacist, which makes it easier to measure out smaller doses (I always get 25 microgram/ml), but that adds expense and time (the nearest compounding pharmacy is 15 minutes drive one way). I just wish I could get 25 microgram tablets, but they can't legally be sold in Australia–possibly I could ask our child psychiatrist to apply for special permission to import them from New Zealand, but the amount of bureaucracy involved probably isn't worth it, there's no guarantee the request would be approved, and it would be expensive (it wouldn't be covered by our national prescription drug insurance).
> 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...
> 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.
> This is not an improvement on existing methods... a case of it being all they have to work with.
But the article says Tilapia skin is better in multiple aspects:
> "We got a great surprise when we saw that the amount of collagen proteins, types 1 and 3, which are very important for scarring, exist in large quantities in tilapia skin, even more than in human skin and other skins," Maciel said. "Another factor we discovered is that the amount of tension, of resistance in tilapia skin is much greater than in human skin. Also the amount of moisture."
It says it's different to human skin in multiple aspects.
Do I need more collagen or more moisture in my skin? I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.
Maybe tilapia skin is better for people who spend 24 hours a day swimming in lakes.
> It says it's different to human skin in multiple aspects.
No it says "even more than in human skin and other skins". Not different.
> Do I need more collagen or more moisture in my skin?
For this context? Yes? Clearly the article answers that already. I even included in my first reply but you'll have a third chance to read it:
> ...which are very important for scarring...
And your attempt to move the goal post fails miserably as well. Or do you think humans evolved to perfection by thinking this:
> I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.
I don't think you are debating in good faith. Good luck.
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
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.
[0]: https://kerecis.com
Yes, it is very mature. The article was written in 2017.
They're incredibly hardy, and unlike most other food fish you can easily grow them in simple container setups.
A female Atlantic mackerel typically lays between 200,000 and 450,000 eggs during a spawning season. However, larger, healthier individuals can sometimes produce up to a million eggs, often in multiple batches over several weeks.
it is the mackerel themselves who consider baby mackerel lives to be industrial in scale. they produce that many in anticipation of consumption. Each foodfish humans consume has already slaughtered untold thousands of other fish to grow themselves to size.
'cause they don't have any feelings" - Something in the way
https://www.youtube.com/watch?v=hg5behq8PlM
If other fish skins were tried it must have been similar results.
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).
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.
https://the-good-doctor.fandom.com/wiki/Not_Fake
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...
Still, an interesting read
https://news.ycombinator.com/item?id=14385336
While it's not a new technique, it's fascinating for this area to be further explored.
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.
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.
I have only seen tilapia sold whole - the skin is one of the best parts when you fry them.
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.
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.
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.
Title needs (2017)
This reminds me of Milton Friedman’s arguments against the FDA.
In the UK and New Zealand, they sell 25 microgram clonidine tablets; in Australia, the smallest dose on sale is 100 micrograms.
Clonidine is a very old drug – it was released back in the 1960s. The risks involved are very well understood (arguably the biggest risk is fatal overdoses, but patient/parent education is the accepted mitigation strategy.)
The issue is, in Australia, it is only approved for treating high blood pressure in adults. Paediatricians and child psychiatrists commonly prescribe it for ADHD, and for anxiety, aggression and insomnia (particularly but not exclusively in the context of ASD); in adults, it is prescribed to treat menopausal hot flushes and migraines – but all those indications are off-label.
And this is the problem – given the doses involved, 25 microgram tablets only really make sense for those off-label indications, there isn't much demand for them for treating adult hypertension. So to get the TGA to approve 25 microgram clonidine tablets, you need to prove to them that clonidine is safe and effective for one of those currently off-label indications. And that will cost a lot of money, and given it is a generic medication long out of patent protection, it isn't worthwhile. Whereas Medsafe quite possibly just decided "the UK approved it for X so we will too".
As a parent, both of whose children are prescribed clonidine, this annoys me – cutting tablets in half is no fun, and cutting them into quarters is even worse. Or I can get them compounded into liquid by a compounding pharmacist, which makes it easier to measure out smaller doses (I always get 25 microgram/ml), but that adds expense and time (the nearest compounding pharmacy is 15 minutes drive one way). I just wish I could get 25 microgram tablets, but they can't legally be sold in Australia–possibly I could ask our child psychiatrist to apply for special permission to import them from New Zealand, but the amount of bureaucracy involved probably isn't worth it, there's no guarantee the request would be approved, and it would be expensive (it wouldn't be covered by our national prescription drug insurance).
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...
> 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.
But the article says Tilapia skin is better in multiple aspects:
> "We got a great surprise when we saw that the amount of collagen proteins, types 1 and 3, which are very important for scarring, exist in large quantities in tilapia skin, even more than in human skin and other skins," Maciel said. "Another factor we discovered is that the amount of tension, of resistance in tilapia skin is much greater than in human skin. Also the amount of moisture."
Do I need more collagen or more moisture in my skin? I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.
Maybe tilapia skin is better for people who spend 24 hours a day swimming in lakes.
No it says "even more than in human skin and other skins". Not different.
> Do I need more collagen or more moisture in my skin?
For this context? Yes? Clearly the article answers that already. I even included in my first reply but you'll have a third chance to read it:
> ...which are very important for scarring...
And your attempt to move the goal post fails miserably as well. Or do you think humans evolved to perfection by thinking this:
> I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.
I don't think you are debating in good faith. Good luck.
Yes, the article you read is from 2017.