Role of early radical debridement and skin cover in diabetic foot ulceration

Objective: To assess the efficacy of radical debridement and skin grafting in treating diabetic foot ulceration, compared with conservative wound treatment. Method: The medical notes for 30 patients who underwent skin grafting for diabetic foot ulceration (graft group) were retrospectively analysed and matched, according to age, gender, ankle brachial pressure index (ABPI) and comorbidities, with 30 other patients, who were treated conservatively (control group). Patients in the graft group underwent early, radical debridennent to prepare the wound bed for grafting. Graft take, rate of ulcer recurrence and donor-site morbidity were assessed. Healing times and the length of hospital stays were compared between the two groups. Results:A 100% skin graft take was recorded in 80% of the patients on day 4, postoperatively. Ninety-three per cent of patients in the graft group completely healed, with 2 patients (6.7%) experiencing ulcer recurrence within the following 6 months. Ulcer recurrence could be due to early, non-guarded ambulation. Mean healing time and hospital stay were significantly lower in the graft group compared with the control group (4.0 +/- 1.5 weeks vs 10.0 +/- 1.0 weeks; p < 0.001). Mean healing time in smokers was slightly greater than non-smokers. Conclusion: Skin graft is an effective method of managing diabetic foot ulcers compared with dressings. It reduced healing times and hospital stay with minimum donor-site morbidity. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.