Durability and Effectiveness of Split-thickness Skin Grafting of the Plantar Foot

Introduction. Split-thickness skin grafting (STSG) is an effective coverage method for chronic foot ulcers. Many of these ulcers develop on the plantar aspect of the foot. Split-thickness skin grafting may be a high-risk operation in such a high wear area. However, outcome data are lacking for patients receiving STSG to the plantar aspect of the foot, especially in terms of recurrence. 

Objective. The purpose of this study is to retrospectively compare outcomes of STSG to plantar and nonplantar chronic ulcers.

Methods. Medical records for all patients receiving STSG from 2014 to 2016 at the authors’ institution were reviewed under IRB approval. Major outcome measures included time to healing and time to ulcer recurrence.

Results. There were 158 patients with 182 STSGs identified. Fifty-two STSGs were located on the plantar surface of the foot and 130 STSGs on a nonplantar surface. Percent take at 30 days was not significant between the 2 groups (56% plantar vs. 60% nonplantar, P = .199). However, plantar surface STSGs were significantly less likely to be healed at 60, 90, and 365 days (P < .05). Split-thickness skin grafting on the plantar surface were 3.7 times more likely to experience a grafting complication (OR, 3.7; 95% CI, 1.82-7.50). After 12 months of follow-up, there was no significant difference in ulcer recurrence (17% plantar vs. 10% nonplantar, P = .172).

Conclusions. Split-thickness skin grafting to the plantar surface of the foot is more likely to experience complications and take longer to heal on nonplantar surfaces, but the durability of the graft approximates that of nonplantar surface grafts. This suggests STSG to the plantar surface of the foot may require more upfront investment from the patient and the surgeon but remains a viable wound coverage option.

Citation: Walters ET, Pandya M, Rajpal N, et al. Durability and effectiveness of split-thickness skin grafting of the plantar foot. Poster presented at: Symposium on Advanced Wound Care Spring; May 7-11, 2019; San Antonio, TX.

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