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Published on: November 19, 2019
Outcomes of Chronically Anticoagulated Patients Undergoing Split-Thickness Skin Grafting for Diabetic Foot Ulcers
Sheldon A McCown1, Elliot T Walters, Alen Palackic
1At the University of Texas Medical Branch, Galveston, Texas, USA, Sheldon A. McCown, BS, is Medical Student, John Sealy School of Medicine; Elliot T. Walters, MD, and Alen Palackic, MD, are Research Fellows, Department of Surgery; Camila Franco-Mesa, MD, is General Surgery Resident, Department of Surgery; Shelby P. Bagby, BA, and Madeline S. Bonnet, BS, are Medical Students, John Sealy School of Medicine; and Steven E. Wolf, MD, is Division Chief of Burns, Trauma, Critical Care, and Acute Care Surgery, Department of Surgery. Acknowledgments: Study funding was provided by Remembering the 15 Burn Research and Education Endowment, NIH (UL1 TR001439). The authors have disclosed no other financial relationships related to this article. Submitted January 2, 2023; accepted January 25, 2023.
Objective:
Split-thickness skin grafting (STSG) is commonly used for wound closure in diabetic foot ulcers (DFUs). In many cases, patients with diabetes present on long-term anticoagulation therapy. The complications associated with anticoagulants can be discouraging to surgeons considering STSG. The goal of this study was to evaluate STSG outcomes in the setting of chronic anticoagulation across a large, multicenter database.
Methods:
The authors queried the TriNetX Network, which provides access to electronic medical records for more than 75 million patients, to search for patients with a history of DFUs treated with STSG. They divided those found into two groups: long-term anticoagulant use prior to grafting and no long-term anticoagulant use. After matching, the researchers evaluated outcomes following STSG after 1 month and 5 years.
Results:
The authors identified 722 patients on chronic anticoagulation with DFUs who were treated with STSG; 446 of these patients were matched to 446 patients with no prior anticoagulation. One month following STSG, the anticoagulated group showed no significant increase in death, graft failure, or regrafting. At 5 years, there was no significant increase in mortality, graft failure, regrafting, or lower extremity amputation rates.
Conclusions:
Chronic anticoagulation therapy does not lead to increased short- or long-term postoperative complications such as graft failure, regrafting, or increased amputation rates following STSG for wound closure. Negative outcomes following STSG for DFUs in chronically anticoagulated individuals are minimal, and grafting should be performed without hesitation.
