Split-thickness skin grafting the high-risk diabetic foot

Abstract

The application of split-thickness skin grafts (STSGs) to chronic extremity wounds has often been considered undesirable because of the perceived high incidence of failure, especially in neuropathic patients with plantar diabetic foot wounds. The purpose of this study was to evaluate the outcomes of STSG placement in patients with chronic lower extremity wounds. We abstracted data from consecutive patients at our institution from January 2007 through April 2013 who underwent STSG placement by vascular and podiatric surgeons for chronic wounds of the lower limb and foot. Patients were monitored for at least 24 weeks, unless the wounds healed sooner. There were 94 patients (72% male) in the study group, with a mean age of 61.0 ± 12.8 years. Of these, 66 patients had diabetes, including 13 who were dialysis-dependent; the remaining 28 had other chronic nondiabetic wounds. The average duration of follow-up was 12.0 ± 12.9 months. After STSG placement, 65 (69.1%) experienced complete graft incorporation and healing, and 18 (19.1%) required revision, five (5.3%) of whom ultimately required major limb amputation. There were no differences in healing when wounds in patients with and without diabetes or plantar vs nonplantar wound locations were compared (P > .05). Similar results were observed after adjusting the results for initial wound size. Although dialysis patients had a threefold higher rate of STSG revision (46.2% vs 14.8%; P = .01), the cumulative rate of wound healing as a function of time was independent of end-stage renal disease (P = .83). The results of this study suggest that STSG may be an effective method for promotion of wound healing in the management of chronic lower extremity wounds irrespective of wound location and presence of diabetes.