Skin grafting as a salvage procedure in diabetic foot reconstruction to avoid major limb amputation

Bone and tendons exposure in diabetic patients requires flap reconstruction to avoid major limb amputation. However, for critical and unstable diabetic patients, revascularization and flap reconstruction may not be feasible. Skin grafts can be used in such a situation, and the purpose of this study is to evaluate this procedure in terms of treatment outcome.

From October 2003 to October 2006, there were 73 critical diabetic cases with bone and tendon exposure at the lower extremities. Repeated debridements were performed to remove the exposed tendon and burr the bare bone until bleeding. Some cases needed adjuvant therapy to promote granulation for skin grafting.

Before skin grafting, thirty cases need toe amputation. The mean presurgical preparation period for a suitable granulation bed was 38.4 days. After skin grafting, wound healing was achieved within 4 weeks in 54 cases, and it took over 4 weeks in 9 cases. In 2 cases, a second skin graft was required.Forefoot stump revision was performed in 3 cases. Total wound healing could not be achieved within 3 months in 5 cases. The complete wound healing rate was 74% in 1 month and 86.3% in 2 months.

In order to preserve the feet, the skin grafting rather than major amputation is suitable for critical and unstable diabetic patients. The drawback is the relatively prolonged treatment course.