We examined complications in eight cases (seven patients) of two-stage, split-thickness skin grafting following artificial dermis grafting for skin-flap harvesting areas on the dorsum of the foot. The mean period until grafting was 36.25 days, and one patient developed pain, discomfort, and late ulceration. Reports to date have indicated that flap harvesting from the dorsum of the foot is prone to complications, including pain and ulceration, even after grafting. However, most of these reports were on one-stage, split-thickness skin grafting; when two-stage, split-thickness skin grafting was performed, the waiting period until grafting was 2-3 weeks, which is shorter than that in our cases. The case in which complications developed in this study had the shortest waiting period until grafting among all eight cases; therefore, it is highly likely that there was insufficient granulation at the time of grafting in this case. Conversely, the cases that required a long waiting period did not develop complications. Thus, complications may be minimized by applying an artificial dermis graft for the flap harvesting area on the dorsum of the foot, continuing treatment until the area is covered with thick granulation tissue, and then performing two-stage, split-thickness skin grafting.

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Many pressure ulcers in spinal cord injury patients tend to be severe and recur because the patients are wheelchair-bound and receive anesthesia. It is important to clarify individual factors of pressure ulcers, but there are few cases reported using our specific method. In our hospital, we questioned a patient regarding his living condition in great detail and extracted data on his condition from our database in order to guide him accordingly. This was an attempt for steady progression and to prevent the ulcers from recurring in the future. In some patients, pressure ulcers are cured without surgery for wound closure, but it requires a long time. We report that our approach to maintaining the living environment and advice on daily life activities were curative without surgery.

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