Document Type : Original research articles
Authors
1
Plastic Surgery Department , Faculty of Medicine, South Valley University, Qena, Egypt.
2
General Surgery Department, Faculty of Medicine, South University University, Qena, Egypt.
Abstract
Background: Split-thickness skin grafts (STSG) use epidermis and partial dermis, applied as mesh or conventional grafts. Nanofat, rich in stem cells and growth factors, aids regeneration. Diabetic foot ulcers remain challenging, needing debridement, dressings, and infection control, with high amputation and mortality risks.
Objectives: To compare STSG versus STSG with nanofat for diabetic foot ulcers regarding esthetic and clinical outcomes.
Patients and methods: This study was conducted at the Plastic Surgery Department, Qena University Hospital, Qena University on 15 cases. Each ulcer was divided into two halves: one treated with STSG alone and the other with STSG plus nanofat, allowing direct intra-patient comparison. STSG involved thigh grafting with meshing and nylon fixation. In the STSG and nanofat group, emulsified lipoaspirates were injected and applied before grafting. Outcomes were assessed weekly using BWAT, scar scales, and Doppler. The Doppler probe handle and cable were covered with sterile disposable sleeves intraoperatively to maintain asepsis.
Results: The mean age was 59.3±7.5 years; 53.3% were female. Diabetes was present in 66.7% and hypertension in 26.7%. Ulcers occurred on the distal leg (46.7%), dorsum (33.3%), and plantar surface (20%), with mean duration 5.2 weeks and graft size 39.7 cm². Nanofat with STSG significantly improved healing time (2.16±0.21 vs. 2.74±0.5 weeks, p=0.0006), BWAT scores (15.67±5.87 vs. 22.2±8.25, p=0.0019), and POSAS outcomes from both patients (1.87±0.81 vs. 3±1.26, p=0.0135) and observers (1.33±1.25 vs. 3.13±1.36, p=0.0021).
Conclusion: Nanofat with split-thickness skin grafts improved diabetic foot ulcer healing, complications, and BWAT/POSAS scores while enhancing scar outcomes.
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