Split-skin graft in the management of diabetic foot ulcers.
OBJECTIVE
To compare the effects of split-thickness skin grafts versus a conservative wound dressing on the healing times of diabetic foot ulcers and the length of hospital stay.


METHODS
In this prospective case-controlled study, 50 patients consented to skin grafting (graft group) and 50 preferred to be managed by conservative dressings (control group). Wound management in both groups was standardised with regard to the dressing materials (which comprised a multilayer dressing including paraffin gauze and diluted povidone-iodine soaked gauze), wound care and surgeon involvement. Graft take, ulcer recurrence rate and donor-site morbidity were assessed. Healing times and the length of hospital stay were compared between the two groups.


RESULTS
A 100% skin graft take was recorded in 84% of the patients on the fifth postoperative day and in 62% on weeks 3 and 8. All patients in the graft group healed completely, but 8% had an ulcer recurrence and 4% a superficial infection within the following year. The mean healing time and mean length of hospital stay were significantly less in the graft group compared with the control group (p<0.001), reflecting results of similar studies.


CONCLUSIONS
Split-skin grafting is an effective method of managing diabetic foot ulcers as, compared with the conservative dressings used in this study, it reduced healing times and the length of hospital stay, while donor-site morbidity was minimal.
Mahmoud
S M
SM
Soba University Hospital, Khartoum, Sudan. abdelsamieabdalla@gmail.com
Mohamed
A A
AA
Mahdi
S E I
SE
Ahmed
M E
ME
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001458:Bandages / Q000191:economics / Q000592:standards*; D015400:Clinical Nursing Research; D003362:Cost-Benefit Analysis; D017719:Diabetic Foot / Q000150:complications / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010232:Paraffin / Q000627:therapeutic use; D011182:Postoperative Care / Q000191:economics / Q000379:methods / Q000451:nursing; D011206:Povidone-Iodine / Q000627:therapeutic use; D011446:Prospective Studies; D017592:Skin Care / Q000191:economics / Q000379:methods* / Q000451:nursing; D016038:Skin Transplantation / Q000191:economics / Q000379:methods* / Q000451:nursing; D013397:Sudan; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
D000891:Anti-Infective Agents, Local; D010232:Paraffin; D011206:Povidone-Iodine