Split-thickness skin grafting the high-risk diabetic foot

Area of Science:

• Dermatology
• Vascular Surgery
• Podiatry

Background:

• Split-thickness skin grafts (STSGs) are often avoided for chronic extremity wounds due to perceived high failure rates, particularly in diabetic patients with plantar foot wounds.
• Evaluating STSG outcomes in chronic lower extremity wounds is crucial for optimizing treatment strategies.

Purpose of the Study:

• To assess the efficacy and outcomes of split-thickness skin graft (STSG) placement for chronic lower extremity and foot wounds.

Main Methods:

• Retrospective data analysis of 94 patients undergoing STSG for chronic lower limb/foot wounds between January 2007 and April 2013.
• Patients were monitored for at least 24 weeks post-procedure.
• Data included wound characteristics, patient comorbidities (diabetes, end-stage renal disease), graft outcomes, and need for revision or amputation.

Main Results:

• Overall graft incorporation and healing occurred in 69.1% of patients.
• No significant differences in healing rates were observed based on diabetes status or wound location (plantar vs. non-plantar).
• Dialysis-dependent patients showed higher revision rates (46.2%), but cumulative healing rates were independent of end-stage renal disease.

Conclusions:

• Split-thickness skin grafting (STSG) is an effective treatment for chronic lower extremity wounds.
• Efficacy is maintained irrespective of wound location or the presence of diabetes.
• STSGs offer a viable option for wound healing in complex patient populations.