Split-Thickness Skin Grafts for Closure of Diabetic Foot and Ankle Wounds

2010 ◽  
Vol 3 (5) ◽  
pp. 231-240 ◽  
Author(s):  
Crystal L. Ramanujam ◽  
John J. Stapleton ◽  
Krista L. Kilpadi ◽  
Roberto H. Rodriguez ◽  
Luke C. Jeffries ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Wound Closure ◽  
Smoking History ◽  
Surgical Reconstruction ◽  
Split Thickness Skin Graft ◽  
Diabetic Patients ◽  
Skin Grafts ◽  
Foot And Ankle ◽  
Thickness Skin

The aim of this study was to determine if split-thickness skin grafts could be successfully used for closure of foot and ankle wounds in diabetic patients. The authors retrospectively reviewed the charts of 100 consecutive patients who underwent a soft tissue surgical reconstruction with split-thickness skin grafts to their foot and/or ankle in our institution from 2005 to 2008. After application of inclusion criteria, 83 eligible charts remained. Of the 83 patients, 54 (65%) healed uneventfully, 23 (28%) required regrafting, and 6 (7%) had a complication resolved with conservative management. All patients had a successful surgical outcome, defined as having achieved complete wound closure at the final follow-up. Surgical outcome was not significantly associated with age, gender, race, hemoglobin A1C, wound size, wound location, illicit drug use, amputation history, Charcot history, or preoperative infection. However, postoperative graft complications were significantly associated with current or previous smoking history (P = .016) and the level of previous pedal amputation to which the split-thickness skin graft was applied (P = .009). This study demonstrates that application of split-thickness skin grafts with an appropriate postoperative regimen is a beneficial procedure to achieve foot and ankle wound closure in diabetic patients.

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

2017 ◽  
Vol 107 (5) ◽  
pp. 365-368 ◽  
Author(s):  
Kyle Sanniec ◽  
Tea Nguyen ◽  
Suzanne van Asten ◽  
Javier La Fontaine ◽  
Lawrence A. Lavery
Keyword(s):  
Skin Graft ◽  
Hba1c Level ◽  
Wound Closure ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Patients With Diabetes ◽  
Early Wound ◽  
Hba1c Levels

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.

Plantar Fibromatosis: A Review of Primary and Recurrent Surgical Treatment

1995 ◽  
Vol 16 (9) ◽  
pp. 548-551 ◽  
Author(s):  
Keith L. Wapner ◽  
Prodromos A. Ververeli ◽  
John H. Moore ◽  
Paul J. Hecht ◽  
Carl E. Becker ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Major Complication ◽  
Primary Group ◽  
Split Thickness Skin Graft ◽  
Consecutive Series ◽  
Revision Procedure ◽  
Thickness Skin ◽  
Plantar Fibromatosis ◽  
Revision Operations

Plantar fibromatosis can be quite disabling to the patient, as well as a technical challenge to the surgeon. Patients who undergo previous local excisions and in whom aggressive recurrences develop are difficult to manage successfully. We present a consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma. The average follow-up was 47 months (range, 22–66 months) in the primary group and 40 months (range, 21–78 months) in the revision group. The overall results were satisfactory in four of the five primary operations, with only one recurrence. In the revision group, five of seven results were satisfactory with no recurrences. The major complication that led to unsatisfactory results was the development of a postoperative neuroma. In this article, we outline our present surgical techniques of wide primary excision and a staged revision procedure with delayed split-thickness skin graft closure. These techniques can be used successfully to manage this disabling, progressive disease.

scholarly journals Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap

2005 ◽  
Vol 38 (02) ◽  
pp. 123-127
Author(s):  
J Joshua ◽  
V Chakraborthy
Keyword(s):  
Skin Graft ◽  
Metatarsophalangeal Joint ◽  
Wound Dehiscence ◽  
Split Thickness Skin Graft ◽  
Wound Coverage ◽  
Thickness Skin ◽  
Secondary Defect ◽  
Metatarsophalangeal Joints

ABSTRACTPlantar metatarsal ulcers and sinuses are frequently seen problems in anaesthetic feet in leprosy. They may occur singly or as multiple sinuses. Many flaps have been described in the management of small defects of the forefoot. During the course of four years, from March 2000 to February 2004, a total of 708 plantar metatarsal ulcers in anaesthetic feet due to leprosy were seen. 280 surgeries were performed on 257 cases. Most of these were debridement and or excision of the metatarsophalangeal joints through a dorsal incision. Thirteen cases were dealt with by a toe web flap, using the plantar metatarsal artery as the source of supply to the flap. Nine were to cover defects under the 1st metatarsophalangeal joint. Three were to cover defects under the second and third metatarsophalangeal joints and one involved coverage of a defect under the 5th metatarsophalangeal joint. In all cases except the last, the big toe contributed the flap. In the last case the fourth toe was the donor. In all cases the flaps survived and did well. The secondary defects were covered with split thickness skin graft. Wound dehiscence was seen in one case and recurrence of a sinus, was seen in one case. Hyperkeratosis of the secondary defect was seen in three cases. Follow up ranged from 3 years to six months. We found this flap to be durable and safe with little chance of recurrence when used to cover plantar metatarsal ulcers.

Antiplatelet Agents In Diabetic Lower Extremity Vascular Disease. A Va Cooperative Study

1981 ◽  
Vol 46 (01) ◽  
pp. 091-091
Author(s):  
J Colwell
Keyword(s):  
Lower Extremity ◽  
Vascular Disease ◽  
Collaborative Study ◽  
Antiplatelet Agents ◽  
Vascular Complication ◽  
Smoking History ◽  
Diabetic Patients ◽  
Vascular Events ◽  
Diabetic Vascular Disease

Peripheral vascular disease is a devastating complication of diabetes mellitus. Post-operative vascular death rates are 10% or more following amputation for gangrene in diabetic patients, and three year mortality approaches 30%. An additional 20-30% of patients require subsequent amputation for diabetic gangrene. In view of these statistics, and because of the postulated role of the blood platelet in diabetic vascular disease, a collaborative study on antiplatelet agents was begun in 10 VA medical centers in 1977. In a double-blinded study, aspirin (325 mg tid) plus dipyridamole (75 mg tid) or placebos are given to adult diabetic males who had suffered a recent amputation for diabetic lower extremity vascular disease. End points are major vascular events after at least 3 years of follow-up.Recruitment of 231 subjects was completed by May, 1980. Baseline characteristics are well matched in both groups. Mean age is 59.6 years, duration of diabetes 12.7 years, smoking history 33.3 pack years, and treatment with insulin 68%. Previous myocardial infarction, congestive heart failure, and/or cerebrovascular disease is present in 17-18% and retinopathy is present in 40% at entry. About 43% have more than one vascular complication at baseline.Mean duration of follow-up is now 18 months. Major vascular events in separate patients are: 40 amputations, 31 deaths, 5 myocardial infarctions. Numerous less serious vascular events have also occurred, as have multiple events in single patients. Therapy has been stopped in 17% of patients, but rarely due to drug side effects. Compliance with therapy has been good.We conclude that this study will provide important new information on the natural history of lower extremity vascular disease in diabetes. It will also provide definitive data about the efficacy of antiplatelet agents in diabetic vascular disease.

scholarly journals CICAFAST: comparison of a biological dressing composed of fetal fibroblasts and keratinocytes on a split-thickness skin graft donor site versus a traditional dressing: a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexandra Poinas ◽  
Pierre Perrot ◽  
Judith Lorant ◽  
Olivier Nerrière ◽  
Jean-Michel Nguyen ◽  
...  
Keyword(s):  
Wound Healing ◽  
Growth Factors ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Fetal Fibroblasts ◽  
Biological Dressing ◽  
Graft Donor

Abstract Background Wound repair is one of the most complex biological processes of human life. Allogeneic cell-based engineered skin substitutes provide off-the-shelf temporary wound coverage and act as biologically active dressings, releasing growth factors, cytokines and extracellular matrix components essential for proper wound healing. However, they are susceptible to immune rejection and this is their major weakness. Thanks to their low immunogenicity and high effectiveness in regeneration, fetal skin cells represent an attractive alternative to the commonly used autologous and allogeneic skin grafts. Methods/design We developed a new dressing comprising a collagen matrix seeded with a specific ratio of active fetal fibroblasts and keratinocytes. These produce a variety of healing growth factors and cytokines which will increase the speed of wound healing and induce an immunotolerant state, with a slight inflammatory reaction and a reduction in pain. The objective of this study is to demonstrate that the use of this biological dressing for wound healing at the split-thickness skin graft (STSG) donor site, reduces the time to healing, decreases other co-morbidities, such as pain, and improves the appearance of the scar. This investigation will be conducted as part of a randomized study comparing our new biological dressing with a conventional treatment in a single patient, thus avoiding the factors that may influence the healing of a graft donor site. Discussion This clinical trial should enable the development of a new strategy for STSG donor-wound healing based on a regenerative dressing. The pain experienced in the first few days of STSG healing is well known due to the exposure of sensory nerve endings. Reducing this pain will also reduce analgesic drug intake and the duration of sick leave. Our biological dressing will meet the essential need of surgeons to “re-crop” from existing donor sites, e.g., for thermal-burn patients. By accelerating healing, improving the appearance of the scar and reducing pain, we hope to improve the conditions of treatment for skin grafts. Trial registration ClinicalTrials.gov, ID: NCT03334656. Registered on 7 November 2017.

Dorsal Adipofascial Turn-Ovesr Flap for Fingertip Amputations

1999 ◽  
Vol 24 (5) ◽  
pp. 525-530 ◽  
Author(s):  
R. E. ÜNLÜ ◽  
A. S. MENGI ◽  
U. KOÇER ◽  
Ö. SENSÖZ
Keyword(s):  
Pedicled Flap ◽  
Split Thickness Skin Graft ◽  
Early Recovery ◽  
Step Procedure ◽  
Thickness Skin ◽  
Exposed Bone ◽  
One Step ◽  
The Mean ◽  
Turn Over

We designed a dorsal adipofascial pedicled flap to cover amputations of the tip of the same digit. This flap includes all the adipofascial tissues from the dermis to the paratenon of the extensor tendons. After elevation of the skin, the adipofascial tissues are raised as a flap and turned over to resurface the exposed bone or joint and then covered with a split thickness skin graft. Ten digital amputations between the distal phalanx proximal to the nail matrix and the mid portion of the middle phalanx were successfully resurfaced with dorsal adipofascial turn-over flaps. All flaps survived completely and the mean follow-up was 11 months. This one-step procedure would seem to be a relatively simple way of achieving early recovery because it does not require the use of distant flaps immobilization of adjacent digits, or homodigital flaps that might jeopardize an already injured finger.

The Use of Split Thickness Skin Grafts in the Correction of Apert’s Syndactyly

2001 ◽  
Vol 26 (1) ◽  
pp. 8-10 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Skin Graft ◽  
Joint Contracture ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Constant Feature ◽  
Apert's Syndrome ◽  
Web Space ◽  
Skin Graft Contraction ◽  
The Web

Stiffness of the interphalangeal joints of the fingers is a constant feature of Apert’s syndrome. Because of this stiffness, the author has used split-thickness skin grafts when correcting Apert’s syndactyly, thinking that contraction of such grafts post-operatively would not cause any joint contracture or finger deviation. This paper reports the results of eight patients whose average age at first surgery was 6 months. Separation of all digits was accomplished before the age of 2 years. A dorsal rectangular flap and interposing triangular digital flaps were utilised to create the web space and partially cover the skin defects in the fingers. The remaining digital defects were covered with thin split-thickness skin grafts which took fully in all cases. At final follow-up (1–6 years), the areas covered by skin grafts have reduced in size significantly because of skin graft contraction. However, this did not result joint contracture or digital deviation.

Results of syndactyly release using a modification of the Flatt technique

2014 ◽  
Vol 39 (9) ◽  
pp. 984-988 ◽  
Author(s):  
A. G. Barabás ◽  
M. A. Pickford
Keyword(s):  
Graft Failure ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Straight Line ◽  
Thickness Skin ◽  
The Mean ◽  
Web Space ◽  
The Web

The results of 144 congenital syndactyly releases over a 12-year period by a single surgeon using a modified Flatt technique (dorsal hourglass flap, interdigitating zigzag flaps, and full-thickness skin grafts) are analyzed considering the association of skin grafts and web creep. The mean follow-up was 5 years. There were seven cases of graft failure, only one of which developed web creep. Web creep occurred in 4.2% of web releases. The results suggest that avoiding longitudinal straight-line scars across the web space may be an important factor in avoiding web creep when performing the modified Flatt technique described.

Impact of Diabetes and Comorbidities on Split-Thickness Skin Grafts for Foot Wounds

2013 ◽  
Vol 103 (3) ◽  
pp. 223-232 ◽  
Author(s):  
Crystal L. Ramanujam ◽  
David Han ◽  
Sharon Fowler ◽  
Krista Kilpadi ◽  
Thomas Zgonis
Keyword(s):  
Postoperative Infection ◽  
Revisional Surgery ◽  
Healing Time ◽  
Successful Outcome ◽  
Prolonged Treatment ◽  
Diabetic Patients ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Delayed Healing

Background: Split-thickness skin grafts can be used for foot wound closure in diabetic and nondiabetic patients. It is unknown whether this procedure is reliable for all diabetic patients, with or without comorbidities of diabetes, including cardiovascular disease, neuropathy, retinopathy, and nephropathy. Methods: We retrospectively reviewed 203 patients who underwent this procedure to determine significant differences in healing time, postoperative infection, and need for revisional surgery and to create a predictive model to identify diabetic patients who are likely to have a successful outcome. Results: Overall, compared with nondiabetic patients, diabetic patients experienced a significantly higher risk of delayed healing time and postoperative complication/infection and, hence, are more likely to require revisional surgery after undergoing the initial split-thickness skin graft procedure. These differences seemed to be related more to the presence of comorbidities than to diabetic status itself. Diabetic patients with preexisting comorbidities experienced a significantly increased risk of delayed healing time and postoperative infection and a higher need for revisional surgery compared with nondiabetic patients or diabetic patients without comorbidities. However, there were no significant differences in outcome between diabetic patients without comorbidities and nondiabetic patients. Conclusions: For individuals with diabetes but without exclusionary comorbidities, split-thickness skin grafting may be considered an effective surgical alternative to other prolonged treatment options currently used in this patient population. (J Am Podiatr Med Assoc 103(3): 223–232, 2013)

scholarly journals Coverage of Giant Sacral Sore With a Gastrocnemius Myocutaneous Flap Pedicled With Femoral Vessels After Thigh Amputation

2017 ◽  
Vol 3 ◽  
pp. 2513826X1772825
Author(s):  
Haodong Lin ◽  
Huihao Chen ◽  
Haoliang Hu ◽  
Chunlin Hou
Keyword(s):  
Spinal Cord ◽  
Myocutaneous Flap ◽  
Surgical Reconstruction ◽  
Pressure Sores ◽  
Skin Grafts ◽  
Flap Necrosis ◽  
Cord Injury ◽  
Femoral Vessels ◽  
Reliable Methods

The purpose of this report was to present the results of coverage of giant sacral sores with a gastrocnemius myocutaneous flap pedicled with femoral vessels after thigh amputation. Between June 1989 and April 2010, 10 patients with paraplegia having giant sacral pressure sores underwent early aggressive surgical debridement followed by surgical reconstruction with a gastrocnemius myocutaneous flap pedicled with femoral vessels after thigh amputation. The spinal cord injury was secondary to trauma in 8 patients and non-traumatic in 2 patients. The wounds measured between 8 cm × 26 cm and 26 cm × 30 cm. The post-operative course was uneventful in 8 patients. Partial flap necrosis occurred in 2 patients who were treated with skin grafts. The follow-up period ranged from 12 to 96 months. There was no recurrence of the sore in any patient. This technique may be a treatment option for the repair of huge sacral bedsores in the absence of other reliable methods for patients with paraplegia.

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