Sanniec Kyle, Nguyen Tea, van Asten Suzanne, Fontaine Javier La, Lavery Lawrence A
J Am Podiatr Med Assoc. 2017 Sep;107(5):365-368. doi: 10.7547/15-200.
There is an increased prevalence of foot ulceration in patients with diabetes, leading to hospitalization. Early wound closure is necessary to prevent further infections and, ultimately, lower-limb amputations. There is no current evidence stating that an elevated preoperative hemoglobin A (HbA) level is a contraindication to skin grafting. The purpose of this review was to determine whether elevated HbA levels are a contraindication to the application of skin grafts in diabetic patients.
A retrospective review was performed of 53 consecutive patients who underwent split-thickness skin graft application to the lower extremity between January 1, 2012, and December 31, 2015. A uniform surgical technique was used across all of the patients. A comparison of HbA levels between failed and healed skin grafts was reviewed.
Of 43 surgical sites (41 patients) that met the inclusion criteria, 27 healed with greater than 90% graft take and 16 had a skin graft that failed. There was no statistically significant difference in HbA levels in the group that healed a skin graft compared with the group in which skin graft failed to adhere.
Preliminary data suggest that an elevated HbA level is not a contraindication to application of a skin graft. The benefits of early wound closure outweigh the risks of skin graft application in patients with diabetes.
糖尿病患者足部溃疡的患病率增加，导致住院治疗。早期伤口闭合对于预防进一步感染以及最终预防下肢截肢是必要的。目前尚无证据表明术前血红蛋白A（HbA）水平升高是皮肤移植的禁忌症。本综述的目的是确定HbA水平升高是否是糖尿病患者应用皮肤移植的禁忌症。
对2012年1月1日至2015年12月31日期间连续53例接受下肢断层皮片移植的患者进行回顾性研究。所有患者均采用统一的手术技术。回顾性分析移植失败和愈合的皮肤移植患者之间的HbA水平。
在符合纳入标准的43个手术部位（41例患者）中，27个愈合且移植成功率超过90%，16个皮肤移植失败。皮肤移植愈合组与皮肤移植未粘连组的HbA水平无统计学差异。
初步数据表明，HbA水平升高不是皮肤移植应用的禁忌症。对于糖尿病患者，早期伤口闭合的益处大于皮肤移植应用的风险。
