SLR - April 2014 - Kerianne E. Spiess
Reference: Rose JF, Giovinco N, Mills JL, Najafi B, Pappalardo J, Armstrong DG. Journal of Vascular Surgery. Feb 8 2014 epub
Scientific Literature Review
Reviewed By: Kerianne E. Spiess, DPM
Residency Program: Temple University
Podiatric Relevance: Diabetic wounds are a costly, time-consuming and challenging aspect of podiatric medicine. Traditionally, most non-healing wounds can be treated in numerous fashions including offloading and advanced therapies. However, there may be potential for the application and harvest of split thickness skin grafts (STSG) as a method of closure. Although this method has been traditionally thought to have diminished results when applied to either diabetics or plantar foot wounds, there may be use for split thickness grafts in the treatment of diabetic foot wounds.
Methods: In this retrospective series, data was collected from 2007 to 2013 at one institution involving split thickness skin grafting by either a podiatric or vascular surgeon for a non-healing plantar foot wound. A total of 94 patients met these criteria, with a mean age of 61 years. Sixty-six of these had diabetes, with approximately 1/3 having insulin dependent diabetes. Patients were also categorized by various risk factors, including age, sex, and presence of renal failure. All patients’ preoperative wounds were granular and had been pre-treated with negative pressure assistive devices. Grafts were harvested routinely from the ipsilateral thigh. Grafts were applied either meshed 1.5:1 or pie crusted, and anchored using chromic gut suture, as well as post operative negative pressure wound therapy. All patients were treated with offloading devices throughout the duration of healing. Patients were followed for a total of 24 weeks or until healing of the wound occurred (if sooner).
Results: After STSG placement, 69.1 percent experienced complete wound healing. The remaining group was treated with local wound care. At the conclusion of the study there were 19 failures (20.2 percent). The success and failure group was not found to have any difference in age or gender. Similarly, there were no differences in wound size or the duration of follow up. It was found that the proportion of plantar wounds was highest in the diabetic group. Of the diabetic group, 44 out of 66 healed primarily, and without revision, which was similar in rates to the non diabetic group. The mean time to healing in the diabetic group was 7.2 +/- 4.7 weeks, and 8.8+/-6.5 weeks in the non diabetic group. There was no statistical significance in healing rates between plantar and non plantar wounds. There was noted to be a three fold increase in revision rates in the ESRD group
Conclusions: Although not typically a first line treatment for closure of plantar diabetic foot wounds, this study has highlighted some potential uses for STSGs. Wound healing, characteristics and patient demographics did not appear to have a statistical significance between diabetic and non diabetic groups. Although further research may be needed regarding clinical outcomes, the use of STSGs may be considered as an option, although the authors make note that a healthy prepared wound bed and use of negative pressure wound therapy also may play a role in the incorporation of the graft.