A case of successful skin transplantation in persistent diabetic foot ulcer

Autor: Matthias Weck, Stefan R. Bornstein, Veit Henkenjohann, Andreas Barthel, Hannes Rietzsch, Ines Panzner, Elena Tsourdi
Rok vydání: 2011
Předmět:
Zdroj: The British Journal of Diabetes & Vascular Disease. 11:103-104
ISSN: 1753-4305
1474-6514
DOI: 10.1177/1474651411405126
Popis: Case report A 65-year-old patient with a long history of type 2 diabetes mellitus and known macro- and microvascular complications was admitted to our clinic due to extensive soft-tissue defects of the foot sole. These defects prove particularly resistant to healing, since they are continuously exposed to pressure. The patient’s initial management included mea sures to optimise glycaemic control and medical treatment of co-morbidities (chronic cardiac and renal failure) as well as extensive debridement, infection elimination by antibiotic therapy based on wound pathogen cultures, the use of moisture dressings and offloading high pressure from the wound bed. 3 The residual perfusion of the affected foot was evaluated by undertaking basic procedures such as measurement of ankle–brachial pressure index (ABPI) and toe pressures as well as colour-flow duplex ultrasonography and by observing the subsequent healing response after initial debridement. The ABPI at the affected side was measured at 0.7 and there were no indications for a significant arterial stenosis on duplex ultrasonography. After exhausting measures of conservative therapy, skin transplantation was performed using a split-skin graft from the patient’s thigh. At that time the wound showed proof of sufficient granulation without any signs of epithelialisation. After preparation of the recipient wound the harvest site was cleansed with ethanol containing solution and lubricated with sterile saline. The harvested split-thickness graft was prepared by fenestrating the graft manually with repeated passes of a surgical scalpel (pie-crusting) or meshing. The graft was stapled in place under slight tension and covered with a bolster dressing. A non-adherent dressing, an absorptive gauze pad and a foam type tape were applied to the harvest site. While the outer dressing was replaced after 5 days, the deep dressing was left in place and gently trimmed until its decay. The donor site healed over the next few weeks. The recipient site was left untouched for the following seven days. Subsequently the bolster dressing was removed and the graft evaluated with the staples removed at 10–14 days. The first weeks after transplantation a complete removal of pressure using footwear with duly formed inserts was undertaken in order to secure adequate offloading of the area and protect the transplant. The patient was subsequently successfully mobilised and discharged home after 20 days (figure 1).
Databáze: OpenAIRE
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