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 A_1c (HbA_1c) level is a contraindication to skin grafting. The purpose of this review was to determine whether elevated HbA_1c 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 HbA_1c 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 HbA_1c 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 HbA_1c 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.