Background: A split-thickness skin graft (STSG) used over exposed tendon, bone, or hardware often fails. In these cases, a dermal regeneration template (DRT) prior to STSG is indicated. Well-studied in the burn population, there is a lack of comparative investigations for chronic wounds. Our study compares short- and long-term outcomes of DRT use in STSG procedures for lower extremity (LE) wounds.
Methods: We reviewed 387 chronic LE wounds in 261 patients undergoing STSG from 2014 to 2022. Outcomes were compared between wounds that received DRT prior to STSG (“DRT”) and those that did not (“Non-DRT”).
Results: Overall, 173 (43.5%) wounds received DRT and 214 (55.3%) did not. Patients had a median age of 62 years (IQR: 14). Major comorbidities were diabetes mellitus (54.4%), peripheral vascular disease (40.0%), and chronic kidney disease (21.8%). No significant demographic differences or wound characteristics (size, depth, location) were observed between groups. Median wound size was 28 cm2 (IQR: 55). The DRT group demonstrated significantly less graft failure (5.2% vs. 19.2%, p<0.001) and significantly higher rates of postoperative ambulation within 30 (43.4% vs. 33.2%, p=0.040) and 60 days (56.6% vs. 42.5%, p=0.006). In a multivariate model, DRT remain protective against graft failure (OR: 0.2, CI: (0.1, 0.4), p<0.001). The reoperation and major amputation rate was 38.0% and 7.3%, respectively, with no differences between groups (p=0.718 and p=0.402). Morality was significantly lower in the DRT group (10.3% vs. 21.5%, p=0.003).
Conclusions: Wounds treated with DRT were more successful in the short-term, with significantly lower failure rates, perhaps contributing to the significantly higher ambulatory rates. However, long-term amputation rates did not show DRT to have the same benefit. Our results suggest the benefit of DRT as a temporizing measure to enhance STSG take and promote ambulation; however, in the long run, DRT use may not mitigate eventual amputation for all chronic LE wound patients.
