Over the past several years, we've had the privilege of working with wound care teams across the Southwest who've made the switch from conventional dressings to advanced biologics. One question we hear consistently is this: should we use Kerecis fish skin or SYLKE spider silk? And the honest answer is: it depends.

Unlike a manufacturer who needs to tout the superiority of their single product, we have the luxury of objectivity. We stock both because clinical evidence supports both. And because the right choice for a 70-year-old with a chronic diabetic foot ulcer is fundamentally different from the right choice for a post-surgical abdomen or a burn. This article walks you through the evidence, the mechanisms of action, and a straightforward framework for deciding which biologic—or when both—makes sense for your patients.

Understanding the Two Technologies

Kerecis: Preserved Extracellular Matrix from Icelandic Cod

Kerecis fish skin is a decellularized extracellular matrix (ECM) harvested from North Atlantic cod skin. The tissue is processed and preserved in a way that maintains the native three-dimensional architecture—collagen, elastin, proteoglycans, and glycosaminoglycans remain intact. Critically, it also retains omega-3 polyunsaturated fatty acids (PUFAs) in concentrations naturally present in the source tissue.

The mechanism is elegant. When applied to a wound bed, the fish skin ECM serves as a biologic scaffold that the patient's own cells recognize and infiltrate. The preserved collagen provides structural support while fibroblasts and endothelial cells migrate through the matrix. The omega-3 PUFAs—particularly EPA and DHA—exert anti-inflammatory effects and promote the production of specialized mediators that facilitate angiogenesis and cell migration.

Kerecis is FDA-cleared for chronic wounds and partial-thickness burns. The company has invested heavily in clinical evidence, particularly through the Odinn Trial, a prospective randomized controlled trial published in Wound Repair and Regeneration. The results: 44% of patients receiving Kerecis achieved complete healing at 16 weeks, compared to 26.4% in the control group receiving standard care[DOI]. A subsequent meta-analysis reported an odds ratio of 3.34[DOI] for healing with Kerecis.

SYLKE: Bioengineered Spider Silk Protein

SYLKE represents a different paradigm. Rather than sourcing tissue from an animal, SYLKE is a recombinant protein derived from spider silk fibroin sequences, manufactured through bioengineering. It's a non-animal-derived, fully characterized biologic dressing that presents a consistent, reproducible wound interface.

The mechanism centers on fibroin's capacity to promote angiogenesis and cellular activity without the immunogenic burden that can accompany animal-derived materials. Clinical studies have shown that SYLKE dressings increase vascular density by 16.3% and vascular branching by 118.6% compared to controls[DOI]. The silk fibroin also enhances fibroblast and endothelial cell migration and proliferation while maintaining a physiologic inflammatory environment.

SYLKE has shown particular strength in surgical and acute wound contexts. Published data demonstrates approximately 29% faster wound closure compared to standard dressings, with significantly lower discomfort (4% in SYLKE vs. 64% in controls) and dramatically reduced local inflammatory response (0% rash vs. 52% in control dressings).

Head-to-Head: When to Use Each

Choose Kerecis When:

• Wound depth and ECM deficit are significant. Full-thickness diabetic foot ulcers (UT Grade 2-3), chronic wounds with exposed subcutaneous tissue or structures, and wounds with a clear need for structural scaffolding. The intact ECM provides genuine three-dimensional support that the wound bed infiltrates over time.
• Chronic non-healing status is established. If a wound has been present for 4+ weeks with conventional care and shows minimal progress, the Odinn Trial data suggests Kerecis tilts the odds toward healing. The 44% vs. 26.4% outcome gap is clinically meaningful at this stage.
• Anti-inflammatory burden is high. Diabetic wounds, in particular, exist in a pro-inflammatory milieu. The omega-3 PUFA content in Kerecis directly addresses this at a biochemical level—these aren't just inert scaffolds; they're active modulators of the inflammatory environment.
• The wound has exposed structures. Tendons, bone, deep fasciae. The preserved ECM of Kerecis provides material that resists enzymatic degradation and offers structural continuity in a way that thin film dressings cannot.

Choose SYLKE When:

• The wound is acute or post-surgical. Clean surgical sites, acute traumatic wounds, donor sites, and split-thickness skin graft beds. The non-animal derivation eliminates concerns about xenogeneic immune response, and the fibroin actively promotes the early vascular and epithelial activity needed in acute healing.
• Patient discomfort is a limiting factor. The SYLKE data showing 4% discomfort vs. 64% control is not trivial in clinical practice. Patients who can tolerate frequent dressing changes and active engagement in care report notably better compliance and perceived healing trajectories with SYLKE.
• Partial-thickness wounds dominate your practice. If your patient population skews toward superficial burns, abrasions, surgical sites, and partial-thickness injuries, SYLKE's mechanism—promoting rapid epithelialization without excessive scarring—is a natural fit.
• Immunologic considerations matter. Patients with severe allergies, previous adverse reactions to animal-derived products, or highly sensitized immune status. SYLKE's bioengineered origin eliminates this variable entirely.

Consider Both in Sequence:

Some of our most experienced colleagues employ a layered approach: initial application of SYLKE in the acute or post-operative phase for comfort and rapid epithelialization, then transition to Kerecis if deeper healing is needed. The spider silk accelerates early vascularization while the ECM scaffold provides the long-term structural support. This isn't redundancy; it's sequential optimization based on wound healing phases.

The Evidence in Context

Both products come with meaningful clinical data, not just marketing claims. The Odinn Trial for Kerecis (44% vs. 26.4% healing) represents a 17.6 percentage point absolute risk reduction—substantial. The odds ratio of 3.34 across meta-analyses demonstrates consistency across diverse patient populations and wound types.

SYLKE's data, while from smaller studies, shows remarkable consistency: 29% faster closure, dramatic reductions in discomfort and inflammatory skin responses. These outcomes matter. A patient who experiences minimal pain during dressing changes is more likely to maintain the regimen. A wound that closes faster, all else equal, reduces infection risk and hospitalizations.

The critical nuance: these products excel in different contexts. Kerecis shows dominant outcomes in chronic wounds in a healing plateau. SYLKE dominates in acute and post-surgical settings. Neither is universally superior; context determines utility.

The Economics of the Decision

As of 2026, both products are reimbursable under appropriate Medicare and commercial insurance plans, though prior authorization often applies. A single Kerecis application typically costs in the range of $600-$1,200 depending on size and formulary negotiation. SYLKE dressings range from $300-$800. Insurance coverage varies by payer and clinical indication, so verification is essential before application.

Here's the economic reality your practice should weigh: a chronic diabetic foot ulcer that heals at 26.4% with standard care may cost the patient, payer, and your practice dearly in extended hospitalizations, infection management, and eventual amputation. The incremental cost of a biologic is often recovered—from a payer perspective—within the first non-healing month if it prevents downstream complications. From a patient perspective, it may be the difference between ambulation and disability.

How to Present This to Your Patients

Transparency builds trust. When discussing biologic options, our recommendation is straightforward:

"You have two advanced options. Both have strong evidence. One comes from fish tissue and works by providing a scaffold plus natural anti-inflammatory compounds. The other is human-made spider silk that accelerates new blood vessel growth. Depending on your wound—how deep it is, how long it's been there, whether it's after surgery or a chronic problem—one may work better than the other. We'll match the science to your situation."

Patients appreciate clarity and choice. They also appreciate that you're not pushing a single product but thinking about their specific wound. That's differentiating in a marketplace flooded with commodity dressings.

Building a Formulary That Works

The strongest wound care practices we work with stock both. Not for hedging bets, but because the evidence supports dual capability. You'll use Kerecis heavily in your diabetic foot ulcer population and chronic wound referrals. You'll use SYLKE frequently in post-operative settings, acute trauma, and burn management. Your team learns the decision tree—depth, acuity, exposure, patient factors—and applies it consistently.

This approach also strengthens your referral relationships. Vascular surgeons appreciate that you offer solutions optimized for post-operative healing. Endocrinologists respect that you're not over-applying expensive biologics to wounds that don't warrant them. Burn centers recognize that your SYLKE experience aligns with their acute care protocols.

The Bottom Line

Kerecis and SYLKE are not competitors in a practice that understands wound healing science. They're complementary tools for different clinical problems. Kerecis excels at providing scaffold and anti-inflammatory support for chronic, deep wounds. SYLKE excels at promoting rapid vascularization and epithelialization in acute and post-surgical contexts, while minimizing discomfort.

The question isn't which is better. It's which is better for this patient, this wound, at this stage of healing. That's the practice of advanced wound care.