Study of efficacy of skin grafting in healing lower extremity ulcers in a rural tertiary care hospital
DOI:
https://doi.org/10.18203/2349-2902.isj20222238Keywords:
Split thickness skin grafting, Full thickness skin grafting, Healing ulcersAbstract
Background: Ulcers are discontinuity of skin/mucous membrane. Chronic ulcers are caused by skin loss that takes long to heal. Skin grafting helps tissue regeneration, hastens healing process. Skin grafts are classified as Split-thickness skin grafts and full-thickness skin grafts. STSG consist of epidermis and some layers of dermis. FTSG consists of epidermis, dermis, and subcutaneous tissue.
Methods: This retrospective and prospective study was conducted on 80 patients diagnosed with healing ulcers of the lower extremity admitted and treated at MVJMC and RH from January 2021-August 2021. Inclusion criteria were patients >18 years, both sexes. Exclusion criteria were patients who were having malignant/TB ulcers and children.
Results: Data was analysed using SPSS-21. In our study, healing ulcers were seen in 80 patients, of which 48 (60%) males and 32 (40%) females. 4 (5%) patients had venous ulcers, 5 (6.25%) varicose ulcers, 10 (12.5%) post burn ulcers, 22 (27.5%) traumatic ulcers, 6 (7.5%) amputated stump and 33 (41.25%) diabetic foot ulcers. STSG 70 (87.5%) and FTSG 10 (12.5%). The uptake was 70-80% in 11 (13.75%), 80-90% in 20 (25%), 90-99% in 24 (30%) and 100% in 25 (31.25%). Complications observed 4 (5%) infections, 5 (6.25%) no graft uptake and 77 (88.75%) had no complications.
Conclusions: Although FTSG can be offered in some cases, STGS is the gold standard in terms of efficacy for healing ulcers. Outcome of the graft depends not only on type of graft also on quality of recipient bed. Skin grafting improves the quality of life in reducing pain.
Metrics
References
Cornwall JV, Doré CJ, Lewis JD. Leg ulcers: epidemiology and aetiology. Br J Surg. 1986;73(9):693-6.
Poskitt KR, James AH, Lloyd-Davies ER, Walton J, McCollum C. Pinch skin grafting or porcine dermis in venous ulcers: a randomised clinical trial. Br Med J (Clin Res Ed). 1987;294(6573):674-6.
Blair SD, Wright DD, Backhouse CM, Riddle E, McCollum CN. Sustained compression and healing of chronic venous ulcers. BMJ. 1988;297(6657):1159-61.
Kanapathy M, Smith OJ, Hachach-Haram N, Bystrzonowski N, Mosahebi A, et al. Protocol for a systematic review of the efficacy of epidermal grafting for wound healing. Syst Rev. 2016;5:92.
Jo LJ, Mus HB, Fish J. Skin grafts. UTMJ. 2009;86: 61-4.
Rose JF, Giovinco N, Mills JL, Najafi B, Pappalardo J, Armstrong DG. Split-thickness skin grafting the high-risk diabetic foot. J Vasc Surg. 2014;59(6):1657-63.
Wood MK, Davies DM. Use of split-skin grafting in the treatment of chronic leg ulcers. Ann R Coll Surg Engl. 1995;77(3):222-3.
Serra R, Amato B, Butrico L, Barbetta A, Caridi G, Massara M, et al. Study on the efficacy of surgery of the superficial venous system and of compression therapy at early stages of chronic venous disease for the prevention of chronic venous ulceration. Int Wound J. 2016;13(6):1385-8.
Ramos JV, Schmidt M, Wu SC. Epidermal skin grafts for the treatment of chronic lower extremity ulcers. Podiatry Manag. 2013, 32:95-104.
Haram N, Bystrzonowski N, Kanapathy M, Edmondson SJ, Twyman L, et al. The use of epidermal grafting for the management of acute wounds in the outpatient setting. J Plast Reconstr Aesthet Surg. 2015;68(9):1317-8.
Sanniec K, Nguyen T, Asten S, Fontaine J, Lavery LA. Split-Thickness Skin Grafts to the Foot and Ankle of Diabetic Patients. J Am Podiatr Med Assoc. 2017;107(5):365-8.
McCartan B, Dinh T. The use of split-thickness skin grafts on diabetic foot ulcerations: a literature review. Plast Surg Int. 2012;2012:715273.
Mohan A, Raruva S, Srinivasan K. Predictive risk factors for lower limb amputations in patients with diabetic foot ulcer in correlation with Wagner’s grading. Predictive risk factors for lower limb amputations in patients with diabetic foot ulcer in correlation with Wagner’s grading. Int Surg J. 2021;8(12):3576-82.
