Split Thickness Skin Grafts for the Treatment of Non Healing Foot and Leg Ulcers in Patients with Diabetes: A Prospective Study
Journal Title: New Indian Journal of Surgery - Year 2018, Vol 9, Issue 5
Abstract
Context: The diabetic foot syndrome is a very severe and common complication in patients with diabetes mellitus with a cumulative lifetime incidence of up to 25 %. Management is based on the simple principles of eliminating infection, the use of dressings, offloading techniques, debridement to accelerate endogenous healing and facilitate the effectiveness of topically applied substances. Timely healing and closure is critical to reducing the cost and morbidity associated with chronic diabetic lower extremity wounds. Split thickness skin grafts (STSG) are a well-known and widely accepted method for soft tissue coverage of open wounds though there are a vast number of wound care products and synthetic grafts available to the clinician today. Aims: Aim is to study the clinical use of STSG in a diabetic population and also identify any risk factors that may affect healing time or lead to complications. Settings and Design: A Prospective with 50 diabetic wound patients during November 2012 and September 2014. Methods and Material: up on admission random sugars and HbA1c were sent and sugars were managed with insulin and drugs. Regular dressing and debridement was done and once granulation appeared posted for skin grafting. Wound size and mean healing times were noted. Results: In our study 32% were seen in 51-60 years age group. According to Wagner’s Grade 70% were in Grade 2, 14 % in Grade 3, 8% in Grade 4. On culture 72% of cases were infected with single organism, 16 % had polymicrobial infections. 26 (52%) patients had wound size < 50cm2, 18 ( 36%) patients had 50-100cm2 and 6 (12%) patients had > 100cm2. The mean healing time was 5.3, 5, 6.2 weeks. There was no significant difference in the healing times of wounds based on the wound size. The mean healing time at STSG site was 6.5 weeks in poorly controlled patients when compared to 5.6 weeks in patients with good glycemic control. Donor site mean healing time was almost similar in all the groups 42 patients had associated morbidities and 8 patients had only diabetes without any other risk factors. 7 cases had complications like infection and failure. Conclusions: Diabetis is emerging cause of non healing foot ulcers and major cause of hospitalisation and surgery. Wound debridement and glycemic control is must for proper wound healing. Once a good granulation appears split skin graft provides adequate cover for the wound.
Authors and Affiliations
R. S. Teja Reddy
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- EP ID EP548597
- DOI 10.21088/nijs.0976.4747.9518.27
- Views 66
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