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Skin Hydration Level as a Predictor for Diabetic Wound Healing: A Retrospective Study

Lee, Tae-Yul M.D.; Kim, Ki-Bum M.D.; Han, Seung-Kyu M.D., Ph.D.; Jeong, Seong-Ho M.D., Ph.D.; Dhong, Eun-Sang M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 848e-856e
doi: 10.1097/PRS.0000000000005474
Reconstructive: Lower Extremity

Background: In the diabetic foot, the skin may crack and develop fissures, potentially increasing vulnerability to ulceration and infection. Therefore, maintaining adequate skin hydration may be crucial for diabetic wound healing. However, no clinical study has addressed this issue. This study aimed to determine and compare the effect of the skin hydration level on diabetic wound healing with that of the tissue oxygenation level, which is recognized as the most reliable parameter in predicting diabetic wound healing.

Methods: This retrospective study included 263 diabetic patients with forefoot ulcers. Skin hydration and transcutaneous oxygen pressure data collected before and after percutaneous transluminal angioplasty were analyzed. Skin hydration and tissue oxygenation were graded as poor, moderate, or acceptable. Wound healing outcomes were graded as healed without amputation, minor amputation, or major amputation. Wound healing outcomes were compared using four parameters: skin hydration at baseline, transcutaneous oxygen pressure at baseline, post–percutaneous transluminal angioplasty skin hydration, and post–percutaneous transluminal angioplasty transcutaneous oxygen pressure.

Results: Each of the four parameters exhibited statistically significant correlations with wound healing outcomes. In the concurrent analysis of both skin hydration and transcutaneous oxygen pressure, skin hydration was a dominant parameter (p = 0.0018) at baseline, whereas transcutaneous oxygen pressure was a dominant parameter (p < 0.0001) following percutaneous transluminal angioplasty.

Conclusions: Skin hydration level might be a useful predictor for diabetic wound healing. In particular, the skin hydration level before recanalization was found to be superior to transcutaneous oxygen pressure in predicting wound healing.


Seoul, Republic of Korea

From the Department of Plastic Surgery, Korea University College of Medicine.

Received for publication January 2, 2018; accepted October 9, 2018.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Seung-Kyu Han, M.D., Ph.D., Department of Plastic Surgery, Korea University Guro Hospital, 148 Guro-Dong, Guro-Ku, Seoul 152-703, Republic of Korea,

Copyright © 2019 by the American Society of Plastic Surgeons