A Prospective Randomised Control Study on Split Thickness Vs Full Thickness Skin Grafting for Non-Healing Ulcer

Background: Non-healing ulcers, commonly resulting from diabetes and vascular diseases, pose significant health and economic challenges. When conservative treatments fail, skin grafting becomes necessary. Among grafting techniques, split-thickness skin grafts (STSGs) and full-thickness skin grafts (FTSGs) are widely used; however, comparative outcomes remain uncertain. This study aimed to evaluate the effectiveness of STSG versus FTSG in healing non-healing ulcers.
Materials and Methods: A prospective randomized controlled trial was conducted at Sree Mookambika Institute of Medical Sciences, Kanyakumari, Tamil Nadu from January 2023 to January 2025. Thirty patients with non-healing ulcers (>3 weeks’ duration) were enrolled and randomly assigned to either STSG or FTSG groups. Patients with infection, plantar ulcers, uncontrolled diabetes, or significant comorbidities were excluded. Healing outcomes, graft uptake, and predictors of recovery time were analysed.    
Results: The mean age of participants was 36.7 ± 13.9 years, with a male predominance (53.3%). Diabetes mellitus was the most common etiology (50%), and lower limbs were the most frequent graft site (73.3%). Complete graft uptake was higher in the STSG group (93.3%) compared to FTSG (73.3%). Larger ulcers (>100 cm²) had a higher risk of graft failure. Healing was faster in the STSG group (5–6 weeks) than FTSG (7–8 weeks). Ulcer size (p = 0.008) and age (p = 0.042) were significantly associated with healing time. Regression analysis confirmed ulcer size and graft type as key predictors (p = 0.000).
Conclusion: STSGs offer superior healing outcomes and faster recovery, supporting their use as the preferred grafting method in non-healing ulcers.