How to Know When a Diabetic Foot Ulcer Needs a Graft or Flap

November is National Diabetes Month, a good time to look closely at one of the most stubborn problems diabetes can cause, including foot ulcers. Research published in The New England Journal of Medicine estimates that 19% to 34% of people with diabetes will develop a foot ulcer during their lifetime. 

Most ulcers heal with careful wound care, pressure relief, and steady blood sugar control. Some wounds grow too large or too deep to close on their own, and they need surgery to cover them with a skin graft or flap. Diabetes makes that repair more fragile, so protecting it takes planning from everyone on your care team.

Read on to learn why some ulcers need surgical closure, what puts the repair at risk, and how hyperbaric oxygen therapy (HBOT) can accelerate diabetic foot ulcer treatment in Marietta.

Why Do Some Diabetic Foot Ulcers Need Surgery?

A foot ulcer may need surgery when it is large, deep, or slow to respond after weeks of standard care. Surgery can also follow a procedure to remove infected tissue or bone, which leaves an opening too big to close with stitches.

Surgeons use two main ways to cover these wounds. A skin graft moves a thin layer of healthy skin from another part of your body, usually the thigh, onto the wound. The graft has no blood supply of its own at first, so it depends on the wound bed underneath to feed it. A flap moves a thicker piece of skin, fat, and sometimes muscle that keeps its own blood vessels. Surgeons choose flaps for deeper wounds or wounds over exposed tendon or bone.

Why Does Diabetes Raise the Risk That a Graft or Flap Will Fail?

Both grafts and flaps need steady blood flow and oxygen to survive their first few weeks. Diabetes, including type 2 diabetes, can interfere with that in several ways:

• Narrowed arteries in the legs and feet reduce blood flow to the repair
• High blood sugar levels slow tissue repair and weaken the white blood cells that fight infection
• Nerve damage can hide pressure or rubbing that injures the new tissue
• Swelling in the foot can press on fragile blood vessels
• Smoking further cuts the oxygen that reaches the wound

When a graft or flap does not get enough oxygen, parts of it can darken, break down, or pull away from the wound.

What Are the Warning Signs of a Failing Graft or Flap?

The first days and weeks after surgery matter most. Call your surgeon or wound care specialist right away if you notice:

• Skin that turns dark purple, gray, or black
• A graft or flap that feels cool compared with the skin around it
• Swelling, drainage, or an odor that gets worse
• Edges that lift or separate from the wound
• New or rising pain, or a fever

Quick action gives compromised tissue its best chance. Patients who need failed flap treatment in Marietta should be seen as soon as these changes appear, since struggling tissue can sometimes recover with prompt care.

How Does HBOT Protect a Skin Graft or Flap?

Hyperbaric oxygen therapy is well documented to support repair before and after surgery. In fact, the Undersea and Hyperbaric Medical Society lists compromised grafts and flaps as an approved use for HBOT. 

During each session, you rest in a pressurized chamber and breathe 99.7% medical-grade oxygen. The added pressure lets your blood plasma carry far more oxygen than usual, so oxygen reaches tissue that poor circulation has left short.

Before surgery, a series of sessions helps the wound bed grow new small blood vessels, which gives a graft a healthier base to attach to. After surgery, HBOT delivers oxygen to new tissue while its blood supply is still forming, helps control swelling, and supports the cells that fight infection. You can learn more in our article on what causes a skin flap to fail.

How Can Your Surgeon and Wound Care Team Work Together?

Your surgeon performs the graft or flap procedure. Hyperbaric Physicians of Georgia does not perform grafts or flaps in the office, so our wound team works alongside your surgeon to prepare the wound and protect the repair. That teamwork can include surgical debridement to clear dead tissue, negative pressure wound therapy to draw out fluid, offloading to keep weight off the foot, and HBOT timed around your surgery date. Your primary care doctor or endocrinologist helps keep blood sugar in a healthy range while you heal.

A question we regularly hear is, “Can I start HBOT before my surgery is scheduled?” In many cases, yes. A hyperbaric physician can evaluate your wound early, confirm that HBOT fits your situation, and coordinate timing with your surgeon so the tissue is in the best shape possible on surgery day.

Where to Get Diabetic Foot Ulcer Treatment in Marietta That Protects Your Repair

Hyperbaric Physicians of Georgia has helped patients heal complex foot wounds since 1993. Our Chief Medical Officer, David Schwegman, MD, FACEP, CWS, is a certified wound specialist who has focused on hyperbaric medicine since 2009. He also served as founding co-chair of the Atlanta chapter of the Save a Leg, Save a Life Foundation, a group dedicated to preventing amputations. Marietta Program Manager Matt Brauninger, CHT, CWS, has directed hyperbaric technical and safety programs in Atlanta since 2005.

Our Marietta team pairs physician-led wound care with HBOT in hard-sided monoplace and multiplace chambers that deliver 99.7% medical-grade oxygen. We have been accredited with distinction by the Undersea and Hyperbaric Medical Society (UHMS) since 2017 and have maintained a 100% safety record since our beginning in 1993.

You will find our Marietta clinic on Whitcher Street near Wellstar Kennestone Hospital, a short drive from Interstate 75 and the Marietta Square.

Ready to protect your foot with diabetic foot ulcer treatment in Marietta?