Background

Diabetic foot ulcers (DFUs) represent a major cause of morbidity and

lower limb amputations in diabetic patients, particularly in low- and

middle-income countries like India. Chronicity, infection, and delayed

intervention often complicate healing. This study aimed to evaluate clinical

outcomes of plastic surgical reconstruction following systemic

optimization and local infection control in patients with complicated

diabetic foot ulcers.

Methods

A prospective observational study was conducted at a tertiary care center in

India, including 67 patients with Wagner grade II–IV DFUs. All patients

underwent systemic infection control, targeted antibiotic therapy based on

culture sensitivity, and glycemic optimization. Depending on wound

characteristics, patients were treated surgically using split-thickness skin

grafting (STSG), local flaps, reverse sural artery flaps, or negative pressure

wound therapy

(NPWT)-assisted

closure. Clinical parameters,

microbiological profiles, infection markers, graft/flap take, and healing

outcomes at 8 weeks were recorded and analyzed.

Results

The mean age of participants was 56.4 ± 9.2 years; 67.2% were male and

94.0% had Type 2 diabetes. Most ulcers were Wagner grade III/IV and

located on the forefoot (53.7%). Culture positivity was observed in 86.6%,

with Staphylococcus aureus and Pseudomonas aeruginosa as predominant

isolates. Post-treatment, CRP and procalcitonin levels showed significant

reductions (p < 0.001). STSG was performed in 47.8% of patients, with a

mean graft take of 95.2%. Complete wound healing at 8 weeks was

achieved in 76.1% of patients, while the mean hospital stay was 11.7 ± 2.9

days. Surgical site infection and partial graft/flap necrosis occurred in

13.4% and 8.9% of patients, respectively.

Conclusion

Plastic surgical reconstruction, when preceded by systemic treatment and

adequate local infection control, offers favorable healing outcomes in

diabetic foot ulcers. Early intervention, appropriate microbial management,

and individualized surgical planning are essential for limb salvage and

reducing re-ulceration rates.