• 1

    Frykberg RG, Zgonis T, Armstrong DG, et al: Diabetic foot disorders: a clinical practice guideline (2006 revision). J Foot Ankle Surg 45 (suppl): S1, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Anderson JJ, Wallin KJ, Spencer L: Split thickness skin grafts for the treatment of non-healing foot and leg ulcers in patients with diabetes: a retrospective review. Diabet Foot Ankle [Published online ahead of print February 20, 2012; doi:].

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Rose JF, Giovinco N, Mills JL, et al: Split-thickness skin grafting the high-risk diabetic foot. J Vasc Surg 59: 1657, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 4

    Ramanujam CL, Stapleton JJ, Kilpadi KL, et al: Split-thickness skin grafts for closure of diabetic foot and ankle wounds: a retrospective review of 83 patients. Foot Ankle Spec 3: 231, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Mahmoud SM, Mohamed AA, Mahdi SE, et al: Split-skin graft in the management of diabetic foot ulcers. J Wound Care 17: 303, 2008.

  • 6

    Puttirutvong P: Meshed skin graft versus split thickness skin graft in diabetic ulcer coverage. J Med Assoc Thai 87: 66, 2004.

  • 7

    Younes N, Albsoul A, Badran D, et al: Wound bed preparation with 10-percent phenytoin ointment increases the take of split-thickness skin graft in large diabetic ulcers. Dermatol Online J 12: 5, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Donegan RJ, Schmidt BM, Blume PA: An overview of factors maximizing successful split-thickness skin grafting in diabetic wounds. Diabet Foot Ankle [Published online ahead of print October 24, 2014; 10.3402/dfa.v5.24769].

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Aerden D, Bosmans I, Vanmierlo B, et al: Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab. J Wound Care 22: 85, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 10

    Thornton JF, Gosman AA: Skin grafts and skin substitutes and principles of flaps. Selected Readings in Plastic Surgery 10: 1, 2004.

  • 11

    Flowers RS: Unexpected postoperative problems in skin grafting. Surg Clin North Am 50: 439, 1970.

  • 12

    Teh BT: Why do skin grafts fail? Plast Reconstr Surg 63: 323, 1979.

  • 13

    Blackburn JH II, Boemi L, Hall WW, et al: Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg 40: 453, 1998.

  • 14

    Schneider AM, Morykwas MJ, Argenta LC: A new and reliable method of securing skin grafts to the difficult recipient bed. Plast Reconstr Surg 102: 1195, 1998.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    McCartan B, Dinh T: The use of split-thickness skin grafts on diabetic foot ulcerations: a literature review. Plast Surg Int 2012: 715273, 2012.

  • 16

    Akhtar S, Ahmad I, Khan AH, et al: Modalities of soft-tissue coverage in diabetic foot ulcers. Adv Skin Wound Care 28: 157, 2015.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 17

    Oh TS, Lee HS, Hong JP: Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg 66: 243, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

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

Kyle Sanniec Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Kyle Sanniec in
Current site
Google Scholar
PubMed
Close
 MD
,
Tea Nguyen Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Tea Nguyen in
Current site
Google Scholar
PubMed
Close
 DPM
,
Suzanne van Asten Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Suzanne van Asten in
Current site
Google Scholar
PubMed
Close
 MD
,
Javier La Fontaine Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Javier La Fontaine in
Current site
Google Scholar
PubMed
Close
 DPM
, and
Lawrence A. Lavery Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Lawrence A. Lavery in
Current site
Google Scholar
PubMed
Close
 DPM
Restricted access

Background:

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 A1c (HbA1c) level is a contraindication to skin grafting. The purpose of this review was to determine whether elevated HbA1c levels are a contraindication to the application of skin grafts in diabetic patients.

Methods:

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 HbA1c levels between failed and healed skin grafts was reviewed.

Results:

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 HbA1c levels in the group that healed a skin graft compared with the group in which skin graft failed to adhere.

Conclusions:

Preliminary data suggest that an elevated HbA1c 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.

Corresponding author: Lawrence A. Lavery, DPM, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. (E-mail: larry.lavery@utsouthwestern.edu)