Evaluating Adverse Outcomes in Anticoagulated Patients Undergoing Skin Grafting for Diabetic Foot Ulcers

Abstract

INTRODUCTION: Split thickness skin grafting (STSG) is a common method for wound closure in patients with diabetic foot ulcers (DFUs). Many diabetic patients have co-morbidities necessitating long-term anticoagulant therapy. These medications may cause surgeons to avoid STSG, but our experience does not warrant such concerns. No published studies examine the risks of skin grafting in the setting of chronic anticoagulation. We posit that anticoagulant therapy has no effect on STSG failure or other adverse outcomes. METHODS: We queried the TriNetX Network, which provides access to electronic medical records for over 75 million patients from 57 healthcare organizations throughout the U.S., for patients with a history of DFUs treated with STSG. We divided those found into two groups: long-term anticoagulant use prior to grafting and no long-term anticoagulant use. Patients were propensity score matched by age and comorbidities. Outcomes following STSG were evaluated at 1 month and 5 years. RESULTS: After matching, we found 429 patients for the matched cohorts. Within 1 month, the anticoagulated group showed no significant increase in graft failure (p = 0.825) or regrafting (p = 0.1243). For long-term outcomes, we found no significant increase in graft failure (p = 0.2797) or regrafting (p = 0.3524) (Figure 1). However, the anticoagulated group had a significant increase in endovascular procedures (p = 0.0096) and amputation (p = 0.0117), and a trend toward death (p = 0.066). CONCLUSION: Anticoagulation therapy does not lead to increased complications after STSG for wound closure, though remain at risk for other complications. All those with diabetic foot ulcers should receive standard of care treatment including STSG when appropriate.