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

Background: 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, outcomes data is lacking for patients receiving STSG to the plantar aspect of the foot, especially in terms of recurrence.

Purpose: The purpose of this study is to retrospectively compare outcomes of STSG to plantar and non-plantar chronic ulcers. 

Methods: Medical records for all patients receiving STSG from 2014-2016 at our 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 non-plantar surface. Percent take at 30 days was not significant between the two groups (56% plantar vs 60% non-plantar, p=0.199). However, plantar surface STSGs were significantly less likely to be healed at 60, 90, and 365 days (p<0.05). STSGs 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% non-plantar, p=0.172).

Conclusions: Split-thickness skin grafting to the plantar surface of the foot is more likely to experience complications and take longer to heal than on non-plantar surfaces but the durability of the graft approximates that of non-plantar surface grafts. This suggests that 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.