Twice Daily Saline Dressing versus Single Dressing before Split Skin Grafting Among Diabetic Foot Ulcer Patients and its Role in the Percentage of Graft Uptake: A Cross-Sectional Study

  • Touzeen Hussain Assistant Professor, Department of General Surgery
Keywords: Diabetes mellitus, Diabetic foot ulcer, Graft uptake, Morbidity, Normal saline dressings, Split skin grafting

Abstract

Objective: The objective of the study is to assess the percentage of graft uptake among diabetic foot ulcer patients undergoing
twice daily saline dressing versus single saline dressing for a week before split skin grafting.
Methodology: This is a cross-sectional study involving 50 diabetic foot ulcer patients, above 18 years of age who have undergone
split skin grafting at Saveetha Medical College. Out of the 50 patients, 25 of them underwent twice daily normal saline dressing,
and the other 25 underwent normal saline dressing once daily before split skin grafting. The percentage of graft uptake after split
skin grafting was assessed at 1st week, 2nd week, and 3rd week and compared between the two groups during regular follow up.
Results: In the study group, out of the 50 patients 33 were male (66%) and 17 were female (34%). Among the study population,
most of them had Type II diabetes mellitus for a period of 1–10 years, 44 patients(88%), and the average duration of ulcer was
<1 month, 32 patients (64%). Average graft uptake among diabetic foot ulcer patients undergoing split skin grafting with single
daily saline dressing for a week before the procedure is, at 1st look 78%, at 2nd look 72%, at 3rd look 69%. The average graft uptake
among diabetic foot ulcer patients undergoing split skin grafting with twice daily saline dressing for a week before the procedure
is, at 1st look 93%, at 2nd look 89%, at 3rd look 87%.
Conclusion: The percentage of graft uptake is higher and better among patients undergoing twice daily normal saline dressing
than among patients undergoing single daily normal saline dressing for a week before split skin grafting. Hence twice daily normal
saline dressing before split skin grafting helps in better graft uptake and wound healing, among diabetic foot ulcer patients which
will greatly help in reducing the morbidity of the disease.

Author Biography

Touzeen Hussain, Assistant Professor, Department of General Surgery

Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

References

1. Gale J. India’s Diabetes Epidemic Cuts Down Millions
Who Escape Poverty. United States: Bloomberg; 2010.
Available from: https://www.bloomberg.com/news/
articles/2010-11-07/india-s-deadly-diabetes-scourge-cutsdown-
millions-rising-to-middle-class. [Last accessed on
2012 Jun 08].
2. Iakovos NN, Malizos C, Vamvakopoulos NC. Protective
and damaging aspects of healing: A review. Wounds
2006;18:177-85.
3. Brem H, Tomic-Canic M. Cellular and molecular basis
of wound healing in diabetes. J Clin Investig 2007;117:
1219-22.
4. Scott G. The diabetic foot examination: A positive step in the
prevention of diabetic foot ulcers and amputation. Osteop
Fam Physician 2013;5:73-8.
5. Barret-Nerin J, Herndon DN. Principles and Practice of Burn
Surgery. New York: Marcel Dekker; 2004.
6. McCartan B, Dinh T. The use of split-thickness skin grafts on
diabetic foot ulcerations: A literature review. Plastic Surg
Int 2012;2012:715273.
7. Janis J, Harrison B. Wound healing: Part II. Clinical
applications. Plast Reconstr Surg 2014;133:383e-92.
8. Provenzano DA, Deer TR. Essentials of Pain Medicine. 4th ed.
Netherlands: Elsevier; 2018.
9. Pak CS, Park DH, Oh TS, Lee WJ, Jun YJ, Lee KA, et al.
Comparison of the efficacy and safety of povidone-iodine
foam dressing (Betafoam), hydrocellular foam dressing
(Allevyn), and petrolatum gauze for split-thickness skin
graft donor site dressing. Int Wound J 2019;16:379-86.
10. Saaiq M, Hameed-Ud-Din KM, Chaudhery SM. Vacuumassisted
closure therapy as a pretreatment for split thickness
skin grafts. J Coll Physicians Surg Pak 2010;20:675-9.
11. Younes N, Albsoul A, Badran D, Obedi S. Wound bed
preparation with 10 percent phenytoin ointment increases
the take of split-thickness skin graft in large diabetic ulcers.
Dermatol Online J 2006;12:5.
Published
2021-09-23
Section
Articles