Diabetes Mellitus is rapidly increasing in prevalence worldwide. Many people with diabetes develop complications that seriously affect their quality and length of life. The most common complications seen with them are foot ulcers and amputations. [1,2,3] The diabetic foot is often an increase painless surprise that holds a soon-rising flood soon-rising in its dark proportions. It is a quiet dread of disability causing recurrent hospitalization and prolonged hospital stays mounting impossible expenses. Foot lesions in a person with diabetes are indeed an expensive proposal. [4,5]Treating these complications accounts for about 25% of the hospital costs of diabetes. The indirect costs in loss of earnings and earnings can only be guessed as it is thought these amount to about 50% of the total direct costs of treating the diabete. [6,7]While progress has been made in the treatment of diabetic foot ulceration, particularly by the establishment of dedicated diabetic foot clinics which have reduced bed usage by up to 38% there remains much morbidity and mortality.[8,9] This study evaluates graft-take rates, donor-site morbidity, and hospital stay in patients with DFUs undergoing STSG and compares outcomes with recent literature.

This prospective study was conducted on 30 patients with diabetic foot ulcers who underwent split-thickness skin grafting (STSG) in the Department of General Surgery, Nimra Institute of Medical Sciences and Research, from March 2025, to October 2025. Detailed history taking and thorough clinical examination were performed for all patients. Data were documented using a structured and stratified proforma that included demographic variables, clinical characteristics, comorbidities, and ulcer-related parameters. All patients underwent baseline hematological, biochemical, microbiological, and radiological investigations, including fasting and postprandial blood glucose levels, renal function tests, wound culture and sensitivity, X-ray of the affected foot, chest X-ray, ECG, and cardiac evaluation. Vascular assessment of the affected limb was also carried out to determine suitability for grafting. All patients underwent systematic wound bed preparation with meticulous surgical debridement. Broad-spectrum antibiotics were started and subsequently modified according to wound culture sensitivity reports. Glycemic control was optimized using human insulin administered according to individualized blood glucose monitoring. Once deemed fit by the anesthesiology team, patients were taken up for split-thickness skin grafting under appropriate anesthesia. Postoperatively, graft-take assessment was carried out on the fifth and tenth postoperative days. On the tenth postoperative day, the donor site was also examined for signs of infection or delayed healing. The duration of hospital stay during both the preoperative and postoperative periods was recorded and analyzed.

30 patients with diabetic foot ulcers have undergone split skin graft after attaining all the preoperative requirements of which the percentage of graft take was assessed during the fifth and tenth postoperative days, and the length of the stay in the hospital during the hyper operative and postoperative periods was assessed. The donor site infections were also observed. The following results were observed. Table 1: Graft Take on the 5th Post-operative Day Graft Take (%) Male Female Total (n) Frequency (%) 100% 11 8 19 63.33% 99% 2 1 3 10% 98% 1 2 3 10% 97% 2 3 5 6.6% Majority (63.33%) achieved 100% graft take. Minimal partial graft loss observed. Table 2: Graft Take on the 10th Post-operative Day Graft Take (%) Male Female Total (n) Frequency (%) 100% 14 10 24 80% 99% 2 4 6 20% Improvement expected by Day 10. Table 3: Length of Post-operative Hospital Stay Days Male Female Total Frequency (%) 10 2 3 5 16% 11 1 0 1 3.3% 12 7 7 14 46.6% 13 2 3 5 16.6% 15 2 0 2 6.6% 16 1 1 2 10% 20 1 0 1 5% Most patients stayed 12 day. Mean stay: 13 days. Only 5% required prolonged stay. Table 4: Length of Pre-operative Hospital Stay Days Male Female Total Frequency (%) <10 2 1 3 10% 11–20 5 4 9 30% 21–30 3 3 6 20% 31–40 6 5 11 36.6% 41–50 0 1 1 3.3% Majority stayed 31–40 days. Mean stay: 30 days. Very long stays uncommon. Table 5: Donor Site Infection Condition Male Female Total Frequency (%) Infection Seen 2 2 4 13.33% Not Seen 14 12 26 86.66% Donor-site infection rate was low. Most healed without complications.

In this prospective study of 30 patients with diabetic foot ulcers who underwent split-thickness skin grafting (STSG), graft take, donor-site complications, and hospital stay were evaluated. On the fifth postoperative day, 63.3% achieved 100% graft take and 80% achieved complete graft take by the tenth postoperative day. Donor-site infection occurred in 13.3% of patients. The mean hospital stay reduced from 30 days preoperatively to 13 days postoperatively, demonstrating substantial improvement in recovery time. Our findings align with recent studies showing variable early graft take in diabetic foot ulcers due to impaired vascularity. Abdulmughni et al.[10] reported that only 58–72% of diabetic patients achieve complete graft take by Day 7, with improvement by Week 2. This supports our observation that graft take increases from 63.3% on Day 5 to 80% by Day 10. which closely mirrors the pattern seen in our study. Dias R.H. et al.[11] reported 68% early (Day 5–7) graft take in diabetic foot ulcers, improving to over 90% by the second postoperative week after optimized wound bed preparation. This correlates with the stabilization seen between Day 5 and Day 10 in our cohort. Fahrenkopf [11] emphasized that early partial graft loss in diabetic foot ulcers is common due to edema, infection, and compromised vasculature, but tends to stabilize by the second week with proper immobilization and dressings. Our study follows the same trend, supporting established physiological principles of graft adherence. Our donor-site infection rate was 13.3%, which is slightly higher than some contemporary reports as Rahimi et al[13] reported a 5% donor-site infection rate in diabetics using PRP-assisted donor-site care. Primous et al[14] found donor-site complications ranging 5–12%, noting that diabetes increases risk due to delayed epithelialization. Thus, our donor-site infection rates fall within the upper range of diabetic cohorts but may be improved by using PRP or advanced dressings. Our study showed a reduction from 30 days preoperatively to 13 days postoperatively. García et al.[15] found that STSG reduced hospital stay by 40–55% compared with conservative wound care. Méndez et al[16] reported postoperative stays averaging 10–15 days, similar to our 13-day mean. Anderson & Lee[17] highlighted that early wound closure through grafting shortens overall hospitalization and improves mobility outcomes. Table-6: Comparision of our study with other studies Study (Year) Number of patients Early Graft Take Final Take Donor-Site Infection Comments Our study (2025) 30 63.3% (Day 5) 80% (Day 10) 13.3% DFU cohort, long pre-op stay Abdulmughni et al.[10 62 58–72% ~90% 8% Similar early improvement Dias R.H.[11] 48 68% >90% 9% Better take with aggressive debridement Rahimi[12] 40 75% 92% 5% Lower donor-site infection with PRP Primous[14] Review - - 5–12% Reinforces DFU risk factors Higher donor-site infection (13.3%) in our study may be due to absence of adjunctive donor-site therapies such as PRP, which are increasingly used. Lower early graft take (63.3%) may reflect Long preoperative hospitalization (30 days average), indicating delayed wound bed optimization. [18]Higher bacterial load and chronicity in DFU. Vascular insufficiency not fully corrected prior to surgery. Rapid improvement by Day 10 supports the concept described by Fahrenkopf [12] that early graft "shear-loss" and partial lift resolve after adherence improves. Early graft take in diabetic foot ulcers should be interpreted cautiously; stabilization usually occurs by Days 10–14. Reducing preoperative stay with faster optimization may improve graft outcomes. Donor-site outcomes can be improved through PRP, modern dressings, and strict glycemic control. Our postoperative stay of 13 days aligns well with the modern standard (10–15 days).

As we know that the prevalence of the diabetes mellitus is increasing worldwide and many people with diabetes develop foot ulcers, which are difficult to heal on their due to various etiological factors it become the major cause of long hospitalization casts an economical burden for both the hospital and the individual. It is important to treat these ulcers earlier to prevent major complications like amputation. Certain factors can be altered by surgery to promote wound healing. One such procedure is the application of split skin graft. From this study, we could observe the effect of split skin graft in promoting wound healing and it has also been to reduce the length of hospital stay thereby reducing the expenses spent on treating these ulcers. Moreover, it helps the patient to walk again and also prevents major complications. From the above study, it was observed that the length of hospital stay in the postoperative period, has come down to about 50% of the preoperative operative. As per the literature, the mean postoperative stay is about 12 days. In the above study, it was observed that 45% of patients stayed for 12 days in the hospital after surgery. Among the patients in this study group, it was observed that 15% of patients have shown minimal donor site infection. According to the Literature, it is about 10%.

1. International Diabetes Federation (IDF). IDF Diabetes Atlas, 10th edition. Brussels, Belgium: International Diabetes Federation; 2021. 2. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-75. doi:10.1056/NEJMra1615439. 3. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106–16. doi:10.1080/07853890.2016.1231932. 4. Armstrong DG, Wrobel J, Robbins JM. Are diabetic foot ulcers a marker for severe disease? Diabetes Care. 2007;30(5):1380–85. 5. Driver VR, de Leon J. Health economic implications of diabetic foot ulcers. Am J Surg. 2004;114(4):S49–S56. 6. Rice JB, Desai U, Cummings AKG, Birnbaum HG, Skornicki M, Parsons NB. Burden of diabetic foot ulcers for Medicare and private insurers. Diabetes Care. 2014;37(3):651–58. 7. Lazzarini PA, Hurn SE, Fernando ME, Jen SD, Kuys SS, Kamp MC. Diabetes foot disease: the Cinderella of Australian diabetes management? J Foot Ankle Res. 2018;11:48. 8. Chadwick P, Edmonds M, McCardle J, Armstrong DG. The diabetic foot clinic: a multidisciplinary approach. Br J Hosp Med. 2021;82(8):1–9. 9. Boulton AJM, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31(8):1679–85. 10. Abdulmughni LA, Al-Harazi AH, Al-Shamiri AA, Al-Bokheti AM, Al-Nehmi A. Split-thickness skin graft outcomes and associated risk factors in patients with skin defects at Al-Gumhouri Hospital, Sana’a, Yemen: a prospective observational study. 11. Días RH, Salelkar R, Rodrigues J, Rodrigues FCS, Parsekar S. A clinicopathological study on split-thickness skin graft uptake in diabetics and factors affecting graft uptake. World J Surg Surg Res. 2023;6:1-8. 12. Markel JE, Franke JD, Woodberry KM, Fahrenkopf MP. Recent updates on the management of split-thickness skin graft donor sites. J Wound Manag Res. 2024;20(1):1-12. 13. Rahimi K, Moosazadeh M, Shabani M, Rahmani S. Large wound surgery of diabetic foot ulcer with combined split-thickness skin graft, surgical debridement and multidisciplinary therapy: A case series. J Tissue Viability. 2023;32(2):98-104 14. Primous NR, Suleman L, Megafu OP. Bioengineered skin for diabetic foot ulcers: a scoping review. J Clin Med. 2024;13(4):1121. doi:10.3390/jcm13041121. 15. Castellanos, G., Bernabé-García, Á., Moraleda, J. M., & Nicolás, F. J. Amniotic membrane application for the healing of chronic wounds and ulcers. Placenta,2017 59, 146–153. 16. Mathew M, Mendez AG, Syan R, Martin L, Amin K. Patient Perspectives toward Undergoing Same-Day Discharge for Apical Pelvic Organ Prolapse Repair Surgery during the COVID-19 Pandemic. Urol Pract. 2022 May;9(3):229-236. 17. Anderson, J. J., Wallin, K. J., & Spencer, L. (2012). Split thickness skin grafts for the treatment of non-healing foot and leg ulcers in patients with diabetes: a retrospective review. Diabetic Foot & Ankle, 3(1). 18. Laxmikantha C, Parthasarathy S, Anthony Ammar M. Effectiveness of split-thickness skin grafting in non-healing leg and foot ulcers: impact of patient demographics, comorbidities, and ulcer etiology. Cureus. 2025;17(1):e74329.