A Novel Wound Therapy Modality: Autologous Wound Edge Dotted Full-Thickness Skin Grafting Improving Diabetic Foot Ulcer Healing

Abstract

Aim: To explore the therapeutic efficacy of autologous wound edge-dotted full-thickness skin grafting in improving diabetic foot ulcer healing. Methods: Sixty-three patients were divided into three groups: conventional wound therapy (CWT) (n = 23), platelet-rich plasma (PRP) (n = 20), and graft (n = 20). All participants were followed up for 12 weeks. The therapeutic efficacy of the three different wound treatment modalities was analyzed. Results: After follow-up, 37 (58.7%) patients showed complete wound re-epithelialization, of which 10 (43.5%) occurred in the CWT group, 14 (70.0%) in the PRP group, and 13 (65.0%) in the graft group. Multivariate Cox analysis showed that the independent predictive factors for ulcer healing were different treatment modalities (graft: HR = 3.214, 95% CI=1.300– 7.945, P < 0.05; platelet-rich plasma: HR = 3.075, 95% CI=1.320– 7.161, P < 0.01), ABI (HR = 9.917, 95% CI=2.675– 36.760, P < 0.01), and TcPO2 (HR = 1.040; 95% CI=1.005– 1.076; P < 0.05). Stratified analysis showed that higher ABI in graft group or PRP group had higher wound healing rate (graft group: HR = 3.748, 95% CI=1.210– 11.607, P < 0.05; PRP group: HR = 5.029, 95% CI=1.743– 14.509, P < 0.05); higher TcPO2 in the graft group had higher wound healing rate (HR = 15.805, 95% CI=4.414– 56.594, P < 0.01). Additionally, the wound healing time ( P < 0.0167) and cumulative healing rate ( P < 0.05) in both the PRP group and graft group were more advantageous. The graft group promotes wound re-epithelialization earlier and faster than in the CWT group and PRP group ( P < 0.05). Meanwhile, the graft group had lower medical costs ( P < 0.0167). Conclusion: Autologous wound edge dotted full-thickness skin grafting has a higher cost-performance ratio than traditional diabetic foot ulcer wound care and is worthy of further clinical application. Keywords: diabetic foot ulcers, autologous wound edge dotted full-thickness skin graft, platelet-rich plasma