J Korean Foot Ankle Soc.  2022 Jun;26(2):78-83. 10.14193/jkfas.2022.26.2.78.

Skin Graft Remains a Clinically Good Treatment Strategy for Chronic Diabetic Wounds of the Foot and Ankle

Affiliations
  • 1Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea
  • 2Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Purpose
The purpose of this study was to evaluate the surgical outcome of split-thickness skin graft (STSG) for chronic diabetic wounds of the foot and ankle.
Materials and Methods
The medical records of 20 patients who underwent surgery for chronic diabetic wounds of the foot and ankle between October 2013 and May 2018 were reviewed. Surgical management consisted of consecutive debridement, followed by negativepressure wound therapy and STSG. We used an acellular dermal matrix between the wound and the overlying STSG in some patients with wide or uneven wounds. Patient satisfaction, comorbidities, wound size and location, length of hospital stay, wound healing time, and complications were investigated.
Results
Of 20 patients, 17 (85.0%) were satisfied with the surgical outcome. Eight patients had diabetic wounds associated with peripheral vascular disease (PVD), 7 patients had diabetic wounds without PVD, and 5 patients had acute infection superimposed with necrotizing abscesses. The mean size of the wound was 49.6 cm 2 . The mean length of hospital stay was 33.3 days. The mean time to wound healing was 7.9 weeks. The mean follow-up period was 25.9 months. Complications included delayed wound healing (4 cases) and recurrence of the diabetic wounds (2 cases), which were resolved by meticulous wound dressing.
Conclusion
STSG remains a good treatment strategy for chronic diabetic wounds of the foot and ankle.

Keyword

Chronic diabetic wound; Skin graft; Negative-pressure wound therapy; Acellular dermal matrix

Figure

  • Figure. 1 (A) A 68-year-old female patient with diabetes mellitus and lymphangitis presented blood-containing blisters on her left foot without a history of trauma. (B) After consecutive debridement for devitalized tissue, healthy granulation tissue growth was confirmed.

  • Figure. 2 (A) A paste-type acellular dermal matrix (ADM) (solid lined arrow) was applied to a bed of granulation tissue followed by an overlying split-thickness skin graft (STSG) (dotted lined arrow). (B) Gauze coated with Vaseline® was used for a skin graft wound dressing and overlying negative-pressure wound therapy (NPWT) was applied. (C) At postoperative 9 months, a patient was satisfied with the surgical outcome and had no discomfort in her daily life.

  • Figure. 3 (A) A 42-year-old male diabetic patient with peripheral angiopathy was well treated with a combination of ADM and STSG with NPWT for a 7x7 cm2 diabetic ulcer of his left ankle. (B) A 73-year-old male patient with a chronic diabetic wound with an acute abscess was also treated with the same protocol for the 8×18 cm2 wound on his right lower leg.


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