Kerecis Fish-Skin Grafts
Kerecis® Omega3 Wound is the intact cod-skin acellular matrix used at KONCEPT® Kingston upon Thames for selected non-healing leg wounds. The decision to use a fish-skin graft is made by a Consultant Vascular & Endovascular Surgeon after a full circulation assessment and wound-care plan, and only where it is the right next step.
255 patients
enrolled in the largest randomised controlled trial of biologic skin substitutes for deep diabetic foot ulcers, comparing intact fish-skin graft to standard of care
Dardari D et al. NEJM Evidence 2024 (15 centres, 4 countries)
16-week
endpoint at which intact fish-skin graft was superior to standard of care for the proportion of wounds healed
Dardari D et al. NEJM Evidence 2024
No known viral transfer
reported between North-Atlantic cod and humans, the reason the manufacturer uses a minimally-processed acellular matrix where human and porcine matrices require heavy processing
Manufacturer information, Kerecis (Coloplast)
KONCEPT® uses Kerecis® Omega3 Wound, an acellular dermal matrix prepared from the intact skin of the North-Atlantic cod (Gadus morhua). The manufacturer, Kerecis, line-catches the cod in Iceland under Iceland Responsible Fisheries Management certification, and prepares the skin in Ísafjörður, Iceland. Kerecis is part of Coloplast.
The skin is decellularised so that no living cells remain, sterilised and packaged as a single-patient sheet. Because there is no known viral transfer between North-Atlantic cod and humans, the matrix is minimally processed (manufacturer information, Kerecis), which is the manufacturer’s stated rationale for preserving the natural dermal structure that other animal- and human-derived matrices typically lose during the heavier processing they require.
The graft is placed on a clean wound bed and acts as a biologic scaffold. The patient’s own cells migrate into the matrix from the wound edge, the graft is gradually incorporated, and the wound surface re-epithelialises.
Kerecis® Omega3 Wound is the European wound-care product. The same manufacturer’s surgical and burn-care ranges are sold under different names internationally (MariGen®, Shield®, GraftGuide®, SurgiClose®, SurgiBind®).
A Kerecis® fish-skin graft is not a first-line dressing. It is considered for selected wounds, by a Consultant Vascular & Endovascular Surgeon, once:
Wounds that may benefit, where the above is met:
Per the manufacturer’s labelling, fish-skin grafts are not applied over infected or deteriorating wounds until the underlying cause has been resolved.
The published evidence is summarised below, with sources. Outcomes vary by wound type, wound bed, and patient factors. No graft “cures” a wound on its own, and the underlying cause must be addressed for healing to be durable.
Dardari D, Piaggesi A, Potier L et al. Intact Fish Skin Graft to Treat Deep Diabetic Foot Ulcers. NEJM Evidence 2024;3(12):EVIDoa2400171. Multicentre RCT, 255 patients, 15 centres in 4 countries. Intact fish-skin graft was superior to standard of care for the proportion of University of Texas grade 2 and 3 ulcers healed at 16 weeks, and was associated with faster time to healing. Study funded by European Commission Fast Track to Innovation Horizon 2020 and Kerecis Ltd, disclosed in the publication.
Kirsner RS, Margolis DJ, Baldursson BT et al. Fish skin grafts compared to human amnion/chorion membrane allografts: A double-blind, prospective, randomized clinical trial of acute wound healing. Wound Repair Regen 2020;28(1):75–80.
Baldursson BT, Kjartansson H et al. Healing rate and autoimmune safety of full-thickness wounds treated with fish skin acellular dermal matrix versus porcine small-intestine submucosa: a non-inferiority study. Int J Low Extrem Wounds 2015;14(1):37–43.
NICE has not published a dedicated medical-technology briefing on fish-skin grafts. The general framework for non-healing wound care remains NICE NG19 (Diabetic foot problems), NICE QS67 (Varicose veins) and NICE NG147 (Peripheral arterial disease), all of which require the underlying cause to be addressed before, alongside, or after any advanced dressing or biologic.
These are taken directly from the Kerecis instructions for use and product website. Always read the full product label before use.
The NHS provides comprehensive care for non-healing wounds, including district nurse, Tissue Viability and vascular surgery services. The NHS pathway remains the right route for many patients. KONCEPT® is designed to complement, not replace, that care.
| Step | Standard NHS approach | What KONCEPT® adds |
|---|---|---|
| Access to a vascular consultant | GP referral, then waiting list to a vascular outpatient clinic. Timing varies by region, specialty and clinical urgency | Direct booking with a consultant vascular surgeon. Same-week appointments subject to availability |
| Wound-cause work-up | Consultation, duplex and ABPI often in separate visits, depending on local availability | Consultation, ABPI and duplex on the same visit where clinically indicated |
| Advanced wound dressings | Provided where local-formulary guidance applies, subject to wound-care prescribing pathways | Day-case fish-skin graft application under local anaesthetic in our procedure room where clinically appropriate |
| Multidisciplinary follow-up | Tissue Viability Nurse and podiatry input depending on local provision | TVN, HCPC Podiatrist and Lymphoedema-trained Physiotherapist support on the same site |
| Cost | Free at the point of use | Self-pay or insurer-funded. Transparent pricing on the pricing page |
| Continuity with your NHS GP | Hospital letter to your NHS GP after each visit, subject to local processes | Clinical summary letter to your NHS GP on request, with your consent, after each KONCEPT® visit |
NHS provision varies by region and clinical context, and the NHS pathway remains appropriate for many patients. KONCEPT® encourages continued NHS GP involvement and shares clinical summaries with your NHS GP on request.
KONCEPT® serves patients across Kingston upon Thames, Surbiton, New Malden, Wimbledon, Richmond upon Thames, Putney, Teddington, Hampton, Esher, Cobham, Walton-on-Thames, Thames Ditton and Twickenham. The clinic sits opposite Kingston railway station (Waterloo 28 minutes direct), with parking nearby and easy access off the A3 from Wimbledon, Putney and central London.
It is an acellular dermal matrix made from the intact skin of the North-Atlantic cod, sterilised but minimally processed so that the natural dermal structure is preserved. It is used as a biologic scaffold on a prepared wound bed. At KONCEPT® we use Kerecis® Omega3 Wound, made by Kerecis, which is part of Coloplast.
It is more accurately described as a biologic scaffold than a transplant. The cells of the cod skin are removed during manufacture, the structural matrix remains, and the patient’s own cells migrate into the matrix as the wound heals.
Selected non-healing wounds where the underlying cause has been addressed and standard care has not achieved closure. Common examples are chronic venous leg ulcers, diabetic foot ulcers (including those with exposed bone or tendon), traumatic and post-surgical wounds with delayed healing.
The most recent and largest randomised controlled trial is Dardari D et al., NEJM Evidence 2024, 255 patients across 15 centres in 4 countries. In deep diabetic foot ulcers (University of Texas grade 2 and 3), intact fish-skin graft was superior to standard of care for the proportion of wounds healed at 16 weeks, and was associated with faster time to healing. The study was funded by European Commission Horizon 2020 and Kerecis Ltd, disclosed in the publication.
NICE has not published a dedicated medical-technology briefing on fish-skin grafts. The general wound-care framework remains NICE NG19 (diabetic foot), NICE QS67 (varicose veins) and NICE NG147 (peripheral arterial disease), which require the underlying cause of the wound to be addressed.
No graft heals a wound on its own. A fish-skin graft is one element of a wound-care plan that has to address the underlying cause (venous reflux, arterial disease, diabetes, infection, compression, footwear). Healing depends on those factors. The graft is considered where the wound bed is ready and standard care has not been enough.
Per the manufacturer’s labelling, a known fish allergy is a contraindication. Note that fish allergy is distinct from shellfish allergy. The graft is not applied over infected or deteriorating wounds until the underlying cause has been resolved. No clinical trials have been conducted in pediatric, pregnant or breastfeeding populations, so the manufacturer does not recommend use in those groups.
A known fish allergy is the contraindication. Patients who eat fish without an allergic reaction are not in that group. The surgeon will confirm allergy history at the consultation.
Application is performed under tumescent local anaesthetic, the same anaesthetic technique used for ambulatory phlebectomy. The local anaesthetic stings for a moment as it goes in. After that, application is not painful.
It depends on the wound. Some wounds re-epithelialise after a single application. Others need repeat applications at intervals. The surgeon discusses this at the consultation and a written plan is provided.
Line-caught North-Atlantic cod, sourced in Iceland under Iceland Responsible Fisheries Management certification. The product is prepared in Ísafjörður, Iceland (manufacturer information, Kerecis).
Most major UK private medical insurers cover vascular wound-care procedures where there is a clinical indication. Call 020 8129 1011 with your insurer and policy details and we will check what your insurer needs from us before any appointment is booked.
Self-pay fees for the consultation, ABPI, duplex, wound-bed preparation and any graft application are published on the vascular surgery pricing page. A written quote is provided before any procedure is booked.
46–48 Wood Street, Kingston upon Thames, KT1 1UW. Opposite Kingston railway station (Waterloo direct, 28 minutes). Parking is available nearby. The clinic is on the ground floor and step-free.
Book a vascular consultation in Kingston. The first visit identifies the cause, sets out a wound-care plan, and decides whether a fish-skin graft is the right next step.