Outcomes of Split Thickness Skin Grafting on Lower Extremity Wounds in Diabetics

Abstract

Background: Split thickness skin grafting is a widely used surgical technique for wound coverage. Despite the popularity of this procedure, outcomes data has been poorly reported. Methods: Under IRB approval we reviewed the records of all patients receiving split thickness skin grafting for lower extremity wounds from 2014 to 2016. We have defined success as wound healing of ≥99.5%. Results: 180 diabetic patients were included in this study. 103 (95%) had hypertension, 75 (69%) had hyperlipidemia, 29 (27%) had congestive heart failure, and 22 (20%) had venous stasis. Complete epithelialization was obtained for 29 (22%) patients at 30d, 48 (36%) patients at 60d, 63 (48%) patients at 90d, and 77 (58%) patients at 365d of follow-up. At last available follow-up 79 (60%) wounds obtained complete healing (≥99.5% coverage). Venous stasis led to inadequate healing at 30d (p<0.0371), 90d (p<0.0006), and 365d (p<0.0005) and trended toward significance at 60d (p<0.0809). Congestive heart failure led to inadequate healing at 60d (p<0.0334), and 90d (p<0.0015). The presence of bacteria on wound bed cultures did not show a significant effect on wound healing. The most common bacteria were coagulase negative Staphylococcus, MRSA, and Enterococcus faecalis. Only enterococcus faecalis showed significance at 30d if present following the initial debridement. Conclusion: The data suggests that split thickness skin grafting can be a successful coverage technique for diabetic patients with chronic lower extremity wounds. The bacterial milieu of chronic wounds in diabetics is diverse but with excisional debridement these bacteria have little impact on wound healing after split-thickness skin grafting. However, comorbidities (i.e., congestive heart failure and venous stasis) can significantly impact the healing of skin grafts and should be taken into consideration when contemplating split thickness skin grafting in a diabetic patient. Disclosure E. Walters: None. G. Stimac: None. N. Rajpal: None. I. Naz: None. T. Elmarsafi: None. J. Steinberg: Consultant; Self; Acelity, Integra LifeSciences. K. Evans: None. C. Attinger: Consultant; Self; Acelity, Integra LifeSciences. P. Kim: Consultant; Self; Acelity, Integra LifeSciences.