# Effectiveness of Split-Thickness Skin Grafting in Nonhealing Ulcers: Impact of Patient Demographics, Comorbidities, and Ulcer Etiology

## TL;DR

This study shows that split-thickness skin grafting helps heal nonhealing ulcers, with healing time influenced by age and graft take.

## Contribution

The study identifies age and graft take as significant predictors of healing time in split-thickness skin grafting for nonhealing ulcers.

## Key findings

- Patients under 40 years had significantly shorter healing times compared to those over 40.
- Graft take percentage was strongly correlated with healing duration.
- Wound size and location did not significantly affect healing time.

## Abstract

Objective: The primary aim of the present study was to evaluate the outcomes of split-thickness skin grafting (STSG) in the management of nonhealing ulcers. The secondary aim was to assess the impact of demographic factors, comorbidities, and ulcer etiology on graft take and overall healing outcomes.

Methodology: This longitudinal, cross-sectional study was conducted in the Department of General Surgery, Shivamogga Institute of Medical Sciences, Karnataka, India, between January 2021 and December 2023. Patients aged 20-60 years with nonhealing ulcers of more than three weeks’ duration and without uncontrolled systemic illness were included. The calculated sample size was 80, of whom 52 underwent STSG and were analyzed for graft outcomes. Grafts were harvested from the thigh using standard techniques, and patients were followed for four weeks to assess healing, graft take, and complications. Data were collected using a structured proforma and analyzed with IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States), applying Student’s t-test, one-way analysis of variance (ANOVA), and Chi-square or Fisher’s exact test, with p < 0.05 considered statistically significant.

Results: In the STSG group (N = 52), the most frequent healing durations were five weeks in 23 (28.9%) patients and six weeks in 22 (27.6%) patients, while early healing at three weeks was observed in only two (2.6%) patients. The mean healing times by wound size were 5.2 weeks for ulcers <50 cm², 4.7 weeks for 50-100 cm², and 5.9 weeks for >100 cm², with no statistically significant difference (ANOVA: F = 1.72, p = 0.19). By location, 18 (22.5%) ulcers were on the right foot, 21 (26.3%) on the right leg, 25 (31.3%) on the left foot, and 16 (20.0%) on the left leg, with mean healing times ranging from 4.6 to 5.7 weeks, also without significant difference (ANOVA: F = 1.68, p = 0.18). Age significantly influenced healing, with patients aged <40 years (50, 62.5%) showing a mean healing time of 4.6 weeks compared with 6.1 weeks in those aged >40 years (30, 37.5%) (t = 4.12, p < 0.001). Graft take was <90% in 27 (33.8%) patients, 90-99% in 26 (32.5%), and 100% in 27 (33.8%), with higher graft take associated with significantly shorter healing times (<90% vs. 90-99%: t = 5.08, p < 0.001; 90-99% vs. 100%: t = 2.12, p = 0.039; <90% vs. 100%: t = 3.25, p = 0.002).

Conclusion: Skin grafting provides favorable healing outcomes in chronic nonhealing ulcers, with age, wound size, and graft take percentage significantly influencing healing duration. Optimizing preoperative wound conditions may enhance graft acceptance and reduce healing time.