Collagen Matrix and Staged Skin Grafting for Plantar Reconstruction: Lessons Learned in Treatment of Palmoplantar Keratoderma.

Background: Tissue defects of the weight-bearing surface of the foot are challenging wounds to reconstruct. Traditionally, skin grafting has had limited success in achieving both a durable and functional construct for ambulation. This case series describes a 2-staged approach to using a collagen bilayer matrix with subsequent skin grafting for plantar reconstruction in 3 sisters with palmoplantar keratoderma (PPK).

Methods: Outcomes of 3 patients (ages 7, 13, and 15 years) who underwent plantar excisions of both feet for treatment of PPK were reviewed retrospectively. Data collection included tissue defect size, duration of non-weight-bearing activity, skin grafting technique, surgical complications, incidence of graft loss, total inpatient stay, and long-term functional status. Sensory outcomes were measured using Semmes Weinstein monofilament testing, along with patient-reported outcomes utilizing the Manchester-Oxford Foot Questionnaire (MOXFQ).

Results: All 3 patients, totaling 6 feet, underwent plantar excisions of PPK. A collagen bilayer matrix was applied, followed by staged skin grafting (mean = 25.5 days between stages). Average total inpatient stay across treatment course was 2.6 days. There were 2 surgical site infections and 2 unanticipated returns to the operating room for excision of PPK recurrence. There were no incidences of graft loss. At an average of 6.9 years follow-up, all 3 patients had an intact reconstruction, preserved protective sensation, and normal gait and shoe-wear. Patient-reported ratings for foot pain varied from poor to excellent.

Conclusions: A method of plantar reconstruction utilizing a collagen bilayer matrix and staged skin grafting is presented, demonstrating excellent long-term durability and functional outcomes.