Skin Grafting as A Salvage Procedure in Diabetic Foot Reconstruction to Avoid Major Limb Amputation

Background: Bone and tendons exposure in diabetic patients requires flap reconstructionto avoid major limb amputation. However, for critical and unstable diabeticpatients, revascularization and flap reconstruction may not be feasible. Skingrafts can be used in such a situation, and the purpose of this study is to evaluatethis procedure in terms of treatment outcome.Methods: From October 2003 to October 2006, there were 73 critical diabetic caseswith bone and tendon exposure at the lower extremities. Repeated debridementswere performed to remove the exposed tendon and burr the bare boneuntil bleeding. Some cases needed adjuvant therapy to promote granulationfor skin grafting.Results: Before skin grafting, thirty cases need toe amputation. The mean presurgicalpreparation period for a suitable granulation bed was 38.4 days. After skingrafting, wound healing was achieved within 4 weeks in 54 cases, and it tookover 4 weeks in 9 cases. In 2 cases, a second skin graft was required.Forefoot stump revision was performed in 3 cases. Total wound healingcould not be achieved within 3 months in 5 cases. The complete wound healingrate was 74% in 1 month and 86.3% in 2 months.Conclusion: In order to preserve the feet, the skin grafting rather than major amputation issuitable for critical and unstable diabetic patients. The drawback is the relativelyprolonged treatment course.