Split-Thickness Skin Grafts to the Foot and Ankle of Diabetic Patients

There is an increased prevalence of foot ulceration in patients with diabetes, leading to hospitalization. Early wound closure is necessary to prevent further infections and, ultimately, lower-limb amputations. There is no current evidence stating that an elevated preoperative hemoglobin A_1c (HbA_1c) level is a contraindication to skin grafting. The purpose of this review was to determine whether elevated HbA_1c levels are a contraindication to the application of skin grafts in diabetic patients.

A retrospective review was performed of 53 consecutive patients who underwent split-thickness skin graft application to the lower extremity between January 1, 2012, and December 31, 2015. A uniform surgical technique was used across all of the patients. A comparison of HbA_1c levels between failed and healed skin grafts was reviewed.

Of 43 surgical sites (41 patients) that met the inclusion criteria, 27 healed with greater than 90% graft take and 16 had a skin graft that failed. There was no statistically significant difference in HbA_1c levels in the group that healed a skin graft compared with the group in which skin graft failed to adhere.

Preliminary data suggest that an elevated HbA_1c level is not a contraindication to application of a skin graft. The benefits of early wound closure outweigh the risks of skin graft application in patients with diabetes.