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

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.

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

Foot & Ankle Specialist ◽

10.1177/1938640010375114 ◽

2010 ◽

Vol 3 (5) ◽

pp. 231-240 ◽

Cited By ~ 26

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.

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The Relationship between Frequently Used Glucose-Lowering Agents and Gut Microbiota in Type 2 Diabetes Mellitus

Journal of Diabetes Research ◽

10.1155/2018/1890978 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

You Lv ◽

Xue Zhao ◽

Weiying Guo ◽

Ying Gao ◽

Shuo Yang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gut Microbiota ◽

Metabolic Diseases ◽

Short Chain Fatty Acids ◽

Current Evidence ◽

Diabetic Patients ◽

Glucose Lowering ◽

Patients With Diabetes ◽

Gastrointestinal Side Effects ◽

Underlying Mechanisms

Metabolic diseases, especially diabetes mellitus, have become global health issues. The etiology of diabetes mellitus can be attributed to genetic and/or environmental factors. Current evidence suggests the association of gut microbiota with metabolic diseases. However, the effects of glucose-lowering agents on gut microbiota are poorly understood. Several studies revealed that these agents affect the composition and diversity of gut microbiota and consequently improve glucose metabolism and energy balance. Possible underlying mechanisms include affecting gene expression, lowering levels of inflammatory cytokines, and regulating the production of short-chain fatty acids. In addition, gut microbiota may alleviate adverse effects caused by glucose-lowering agents, and this can be especially beneficial in diabetic patients who experience severe gastrointestinal side effects and have to discontinue these agents. In conclusion, gut microbiota may provide a novel viewpoint for the treatment of patients with diabetes mellitus.

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Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-11-02-0033 ◽

2012 ◽

Vol 25 (01) ◽

pp. 42-48 ◽

Cited By ~ 1

Author(s):

S. C. Ralphs ◽

G Coronado ◽

D. C. Sweet ◽

J. Ward ◽

C. P. Bloch ◽

...

Keyword(s):

Surgical Technique ◽

Skin Graft ◽

Clinical Case ◽

Subcutaneous Tissue ◽

Skin Grafts ◽

Full Thickness ◽

Preparation Methods ◽

Full Thickness Skin ◽

Thickness Skin ◽

Significant Difference

SummaryObjective: To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts.Study design: Ex vivo experimental study and a single clinical case report.Sample population: Four canine cadavers and a single clinical case.Methods: Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample.Results: The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens.Clinical significance: The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.Presented at the ACVS symposium during the resident seminar, Seattle, Washington,USA on October 22, 2010.

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Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽

10.1515/med-2018-0048 ◽

2018 ◽

Vol 13 (1) ◽

pp. 304-323 ◽

Cited By ~ 3

Author(s):

Hernando Vargas-Uricoechea ◽

Manuel Felipe Cáceres-Acosta

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Angiotensin Receptor Blockers ◽

Pharmacological Therapy ◽

Current Evidence ◽

Diabetic Patients ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Patients With Diabetes ◽

The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

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The Correlation between Clinical and Demographic Parameters and Sickness Absence in Diabetic Employees

Healthcare ◽

10.3390/healthcare9101309 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1309

Author(s):

Oren Zack ◽

Irena Golob ◽

Gabriel Chodick ◽

Idan Perluk ◽

Rachel Raanan ◽

...

Keyword(s):

Medical Records ◽

Pearson Correlation ◽

Severity Of Illness ◽

Diabetic Patients ◽

Telephone Interviews ◽

Public Sector Employees ◽

Patients With Diabetes ◽

Absence From Work ◽

Control Study ◽

Hba1c Levels

Objectives: Diabetes mellitus is one of the most significant and prevalent chronic diseases. Individuals with diabetes can still encounter substantial difficulties in finding and keeping their job because of their condition. The purpose of this study was to examine the scope of diabetes-related absence from work and its relationship with variables such as type of employer, workload, the severity of illness, and type of treatment. Materials and Methods: We conducted a case-control study, including 220 diabetic patients and 230 controls. Information regarding absence from work was obtained by reviewing medical records, and general patient information was retrieved by conducting telephone interviews. Results: Patients with diabetes had, annually, more days of absence than non-diabetic patients (8.5 vs. 2.7, respectively p and lt; 0.001). Among diabetic patients, public-sector employees were absent more than private-sector employees (9.0 vs. 7.2 days, respectively, p and lt; 0.05). A positive correlation was found between workload (measured by stamina) and absence (Pearson correlation = 0.098, p = 0.04). Concerning the clinical variables, we found that employees suffering from diabetic complications exhibited higher absence rates (15.5 vs. 5.7 days, respectively, p and lt; 0.003). Parameters like HbA1c levels, patient age, disease duration, and type of treatment did not differ significantly amongst the groups with regards to absence rates. Conclusions: The main variables affecting absence from work were not medical but rather sociodemographic: education, workload, and type of employer. The results of this study reinforce the perception that well-controlled diabetic employees can be combined in most types of occupations without fear of increased absence from work.

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Effect of Different Factors on Glycosylated Hemoglobin (HbA1c) Levels Among Diabetes Mellitus Patients

10.53350/pjmhs2115123513 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3513-3515

Author(s):

Bader Alsuwayt

Keyword(s):

Diabetes Mellitus ◽

Glycated Hemoglobin ◽

Glycosylated Hemoglobin ◽

Diabetic Patients ◽

Study Results ◽

Patients With Diabetes ◽

Insulin Use ◽

Low Rate ◽

Statin Use ◽

Hba1c Levels

Aim: To describe the rate of the controlled level of glycosylated hemoglobin (HbA1c) among diabetes mellitus patients in Dammam city, Kingdom of Saudi Arabia (KSA). To assess the association between the status of HbA1c and the different patient-related factors namely: insulin use, metformin, dyslipidemia, and statin use. Methods: This cross-sectional study was performed at Security Forces Hospital, Dammam, KSA, between November 2020 and February 2021. A sample of two hundred known diabetic patients who were regularly followed up at the outpatient department (OPD) was selected randomly for the current study. Results: A very low rate (24%) of controlled HbA1C levels in patients with diabetes (type 1 DM and type 2 DM), The data showed that 85 % of all participants in our study are T2DM patients, while only 15% are T1DM patients, Our data showed that patients with dyslipidemia, hypothyroidism, or hypertension have a high level of uncontrolled HbA1C levels. Surprisingly, both dyslipidemia and statin use were predictors of uncontrolled HbA1C, Unexpectedly, non-metformin use has a protective effect toward controlling HbA1C, While insulin use is a strong predictor of uncontrolled HbA1C (OD 5.20). Conclusion: A low rate of controlled glycated hemoglobin (HbA1c) level among patients with diabetes (T1DM and T2DM) in our sample urges the need for immediate intervention to investigate and improve the current findings. Further investigations are needed to fully explain the high rate of uncontrolled HbA1c among insulin, metformin and statins users. Keywords: Glycated hemoglobin, HbA1c, Diabetes mellitus, Statins, Metformin.

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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 ◽

10.1186/s13063-019-3718-4 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 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.

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

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0507 ◽

2001 ◽

Vol 26 (1) ◽

pp. 8-10 ◽

Cited By ~ 6

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.

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The Association of Depression and the Cardiovascular Risk Factors of Blood Pressure, HbA1c, and Body Mass Index among Patients with Diabetes: Results from the Translating Research into Action for Diabetes Study

International Journal of Endocrinology ◽

10.1155/2012/747460 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Lindsay B. Kimbro ◽

W. Neil Steers ◽

Carol M. Mangione ◽

O. Kenrik Duru ◽

Susan L. Ettner

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Health ◽

Diabetic Patients ◽

Cross Sectional ◽

Patients With Diabetes ◽

Patient Health ◽

Hba1c Levels

Diabetic patients are nearly three times as likely to have depression as their nondiabetic counterparts. Patients with diabetes are already at risk for poor cardiovascular health. Using cross-sectional data from the translating research into action for diabetes (TRIAD) study, the authors tested the association of depression with cardiovascular risk factors in diabetic patients. Depression was measured using the patient health questionnaire (PHQ8). Patients who scored greater than 9 on the PHQ8 were classified as depressed and were compared with those who were not depressed(n=2,341). Depressed patients did not have significantly different blood pressure levels than those who were not depressed. However, those who were depressed had higher HbA1c levels than those who were not depressed(P<0.01)and higher BMIs than those who were not depressed(P<0.01). These results indicate that depressed diabetic patients are at greater risk of having poor control of cardiovascular risk factors and suggest that depression screening should be a standard practice among this patient group.

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Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.02.14 ◽

2021 ◽

Vol 14 (2) ◽

pp. 269-276

Author(s):

Rui-Fang Feng ◽

◽

Ya-Lu Liu ◽

Qing Xu ◽

Lei Qiao ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Hba1c Level ◽

Onset Age ◽

Diabetes Onset ◽

Patients With Diabetes ◽

High Hba1c ◽

Independent Risk Factors ◽

Hba1c Levels

AIM: To assess the effect of age at diabetes onset and uncontrollable high HbA1c levels on the development of diabetic retinopathy (DR) among Chinese type 2 diabetes mellitus (DM) patients. METHODS: This was a cross-sectional survey of diabetic patients in Subei district, China. Data covering physical measurements, fasting blood-glucose (FBG), glycosylated hemoglobin (HbA1c), blood lipid, urinary albumin/creatinine ratio (UACR), ocular fundus examination, and diabetes treatment records were collected. An independent sample t-test were used to analyze differences. A Logistic regression analysis was applied to study the independent risk factors of DR. RESULTS: A total of 1282 patients with type 2 DM were enrolled, and 191 cases had DR (14.9%). The age at diabetes onset, education level, alcohol consumption, HbA1c level, UACR level, and hypoglycemic drugs were independent influencing factors for DR. The older the onset of diabetes, the less likely to develop DR (OR: 0.958, 95%CI: 0.942-0.975, P=0.000). Patients were then divided in terms of age at diabetes onset as follows: <50y, 50-59y, 60-69y, and ≥70y. Compared with diabetes onset age <50y, 50-59y (OR: 0.463, 95%CI: 0.306-0.699, P=0.000), 60-69y (OR: 0.329, 95%CI: 0.203-0.535, P=0.000) and ≥70y (OR: 0.232, 95%CI: 0.094-0.577, P=0.002) were at a lower risk of DR. The prevalence of DR was highest in patients with diabetes onset age <50y (29.5%, P<0.05). The HbA1c level (8.67±1.97)% and proportion of insulin injection (52.5%) in patients with diabetes onset <40y were higher than in patients with older diabetes onset age (P<0.05). CONCLUSION: Diabetes onset at an earlier age and uncontrollable high HbA1c level could be independent risk factors for DR.

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