Abstract
Diabetic foot ulcerations are historically difficult to treat despite advanced therapeutic modalities. There are numerous modalities described in the literature ranging from noninvasive topical wound care to more invasive surgical procedures such as primary closure, skin flaps, and skin grafting. While skin grafting provides faster time to closure with a single treatment compared to traditional topical wound treatments, the potential risks of donor site morbidity and poor wound healing unique to the diabetic state have been cited as a contraindication to its widespread use. In order to garner clarity on this issue, a literature review was undertaken on the use of split-thickness skin grafts on diabetic foot ulcers. Search of electronic databases yielded four studies that reported split-thickness skin grafts as definitive means of closure. In addition, several other studies employed split-thickness skin grafts as an adjunct to a treatment that was only partially successful or used to fill in the donor site of another plastic surgery technique. When used as the primary closure on optimized diabetic foot ulcerations, split-thickness skin grafts are 78% successful at closing 90% of the wound by eight weeks.
Highlights
There are many means of treating diabetic ulcerations
In an effort to determine the efficacy of this treatment, a literature review was undertaken to evaluate the outcomes of Split-thickness skin grafting (STSG) in diabetic patients
Twenty-two articles were yielded from the initial search [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27], with four articles found addressing STSG on diabetic wounds [6,7,8,9]
Summary
There are many means of treating diabetic ulcerations. A conservative approach may entail regular debridement and dressing changes. It is important to debride fibrotic wounds This can be done mechanically by applying saline wet to dry dressings, and after the dressing is changed, it removes fibrotic tissue with it. There are several bioengineered products that may facilitate wound closure once the wound is infection-free and has a primarily granular base These materials help deliver fibroblasts to wounds and help serve as a scaffold for new tissue growth. More advanced flaps are ideal for plantar or weight-bearing wounds because they have more substance and contain their own blood or nerve supply which increases graft take. These are indicated in wounds with avascular bases such as directly over tendons, or bone without periosteum. If a flap is not possible, split-thickness skin grafts may be the better treatment option to close challenging wounds once a granular base is achieved
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