A Meta-Analysis of the Outcomes of Split-Thickness Skin Graft on Diabetic Leg and Foot Ulcers

Abstract

Diabetic lower limb ulcers are a serious complication to diabetes that could lead to amputation and death. Split-thickness skin graft (STSG) has been proposed by some authors to treat noninfected diabetic wounds, mainly those found in the leg and on the dorsum of the foot. No quantitative evidence synthesis over this technique has been reported in the literature. The study is a meta-analysis on the effectiveness of STSG in treating diabetic leg and foot ulcers. Electronic databases were searched from inception. No limitation was imposed on study design. Eleven studies comprising 757 patients with 759 foot/leg ulcers were included. After a mean period of 2 years, 85.5% (95% confidence interval [CI] = 0.766-0.925) of ulcers were healed over a mean time of 5.35 ± 2.25 weeks, with a recurrence rate of 4.2% (95% CI = 0.009-0.096), an infection rate of 4.4% (95% CI = 0.013-0.092), and a regrafting rate of 12.1% (95% CI = 0.053-0.212). Infection was the only reported donor site morbidity with a frequency of 1.74% (95% CI = 0.001-0.048). These weighted values are found to be noticeably superior to those reported in the literature following standard conventional care. The results of the review make STSG the ideal method to treat noninfected recurrent or recalcitrant ulcers of the leg and dorsal foot. Furthermore, the authors argue that STSG should be used more frequently in the management of such wounds. The findings should encourage future prospective investigations.

Use of Nevelia Dermal-Epidermal Regenerative Template in the Management of Ischemic Diabetic Foot Postsurgical Wounds

“…Certainly, the choice to follow the standard protocol and to perform a skin graft after the application of a DES is the usual choice 24,25 ; however, our experience also supports the use of this type of DES and under which conditions a skin graft is not be performed.…”

“…DFUs can be sources of unstable scars and increase the risk of recurrence. 25 Nonetheless, the quality of the new skin, without scars, observed in our patients could significantly reduce the risk of relapse, mainly in the loading areas.…”

Limb salvage procedure in immunocompromised patients with therapy‐resistant leg ulcers—The value of ultra‐radical debridement and instillation negative‐pressure wound therapy

“…A total of 86% diabetic ulcers achieved complete wound closure. The recurrence rate was 4.2% in this meta‐analysis 52 . Diabetic leg, foot, and ankle wounds had wound healing rates of up to 70% after STSG in previously published case series 53,54 .…”

“…The recurrence rate was 4.2% in this meta-analysis. 52 Diabetic leg, foot, and ankle wounds had wound healing rates of up to 70% after STSG in previously published case series. 53,54 Rose et al, however, reported on a major limb amputation rate of 6% in diabetic wounds.…”

Randomized research on the mechanism of local oxygen therapy promoting wound healing of diabetic foot based on RNA-seq technology

“…(V) Skin replacement therapy: compared with stem cell therapy, skin grafting could be proposed to treat noninfected diabetic wounds directly. A meta-analysis (19) indicated that, after a mean of 5.35 weeks, the rate of healed DF skin grafting was 85.5%, with recurrence, infection and regraft rates of 4.2%, 4.4% and 12.1%, respectively. However, considering the skin basis of patients with DF, the longer healing time limits the use of this method, spawning skin regeneration matrices for DF skin grafting, such as Integra, Nevelia, MatriDerm, Pelnac and Renoskin (20), but the high cost is a barrier to the application of these biological matrices.…”