IDF21-0620 Results of split thickness skin grafts in revascularized diabetic foot ulcers patients

Abstract

Background: Split thickness skin grafts (STSG) have been shown to improve healing of diabetic foot ulcers (DFU) in non-ischemic patients. There were no previous studies to assess the results of STSG in ischemic revascularized legs. Aim: To assess the results of STSG in patients presenting with DFU and critical limb threatening ischemia (CLTI), who underwent revascularization, in comparison with non-ischemic patients. Method: Retrospective case control study. The data of all consecutive patients who had STSG for DFU at our center between 1st of January 2020 and 31 of December 2020 were reviewed. They were divided into two groups: group A included patients with CTLI who underwent revascularization prior to STSG, and group B included non-ischemic patients who had STSG. DFU were treated along standard lines regarding debridement, off-loading of plantar ulcers, and treatment of infection. DFU in CLTI were treated by revascularization, using endovascular approach mainly. Optimization of the general condition was performed prior to STSG. Negative pressure wound therapy was applied until the wound was covered with healthy granulations, then STSG was performed. All patients were followed for a minimum of 6 months. End points were rate of healing, duration of complete wound healing, major amputation and death. Results: There were 61 patients: Group A: 37 & Group B 24. 78% were male and all were diabetics. No statistical differences were found between both groups regarding the demographic factors and risk factors, and the local wound condition regarding size, location, and wound class according to WIFI classification. Complete wound healing was achieved in 80% in group A versus 92.3% for group B within 6 months (NS). The mean time to complete healing was 31.5 (SD 44.7) days in Group A and 22.2 (SD 21.5) days in group B (NS). One patient had major amputation due to infection and 2 patients died due to unrelated causes, all were in group A. Discussion: STSG was not previous reported following revascularization in patients suffering CLTI and DFU. Although this study showed longer time to achieve complete wound healing in revascularized patients as compared to non-ischemic DFU, the healing rate of the revascularized group (80%) and the mean healing time (31.5 days) were still improved as compared to our own historical data of non-ischemic patients with DFU who did not receive STSG.