Outcomes of dermal regeneration template and split-thickness skin grafts in lower extremity wound closure: an 8-year retrospective analysis.

Abstract

Background: Split-thickness skin grafts (STSG) over tendon or bone often fail. In such cases, an attempt to create a neo-dermis or restore a dermal-like covering is indicated. This study compared the outcomes of dermal regeneration template (DRT) use in lower extremity (LE) wound closure when combined with STSG procedures.

Methods: Medical records of patients with chronic LE wounds who underwent STSG from 2014 to 2022 were reviewed. Wounds that were treated with DRT prior to STSG ("DRT") were compared those that were not ("non-DRT"). Both groups were acquired concurrently over the 8-year period. All outcomes evaluated were in relation to the STSG procedure.

Results: A total of 387 wounds in 261 patients were identified. One hundred seventy-three (43.5%) wounds were treated with DRT and 214 (55.3%) were not. No demographic differences were observed between the 2 groups. Prevalent comorbidities included diabetes (54.4%) and peripheral vascular disease (40.0%). Median wound size (28 cm2, interquartile range: 55) and depth were similar between the groups. The DRT group demonstrated significantly less graft failure than the non-DRT group (5.2% vs. 19.2%, respectively; P < .001) and higher rates of postoperative ambulation within 30 days (48.7% vs. 36.0%, respectively; P = .040) and 60 days (63.6% vs. 42.6%, respectively; P = .006). In a multivariate model, DRT independently reduced STSG failure and infection but not reoperation or amputation. Mortality trended to be lower in the DRT group (12.4% vs. 18.6%, P = .172).

Conclusions: DRT plays a key role as a temporizing measure to significantly enhance STSG take and promote ambulation in patients with chronic wounds but does not decrease the need for future major limb amputation.