Co esponding au ho : Muhammad Asim Saad
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
P e alence and isk ac o s o lowe limb skin g a ailu e in Pakis ani pa ien s
A oza Tajuddin 1 and Muhammad Asim Saad 2, *
1 Mas e o Science in Nu sing, Aga Khan Uni e si y School o Nu sing and Midwi e y.
2 BS public heal h, Uni e si y o Ka achi.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1378-1383
Publica ion his o y: Recei ed on 10 July 2025; e ised on 16 Augus 2025; accep ed on 18 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2975
Abs ac
Backg ound: Lowe limb skin g a ing is a common econs uc i e p ocedu e, bu g a ailu e emains a signi ican
challenge. Mul iple pa ien - and p ocedu e- ela ed ac o s can in luence ou comes.
Objec i e: To e alua e demog aphic, clinical, and su gical a iables associa ed wi h lowe limb skin g a success and
ailu e.
Me hods: This obse a ional s udy included 79 pa ien s unde going lowe limb skin g a ing o indica ions including
cance , auma, ulce s, and elec i e econs uc ion. Demog aphic cha ac e is ics, como bidi ies, p ocedu al de ails, and
pos ope a i e ou comes we e eco ded. Va iables we e compa ed be ween g a success and ailu e g oups, and
s a is ical signi icance was assessed.
Resul s: The mean age was 28.5 ± 11.2 yea s, wi h 41 males and 38 emales. Hype ension (n=75) and diabe es melli us
(n=62) we e he mos p e alen como bidi ies. The mos common indica ion o g a ing was cance (n=23), and spli -
hickness g a s we e mos equen ly used (n=70). G a ailu e occu ed in 28 cases (35.4%). Signi ican p edic o s o
g a ailu e included olde age (median 73 s. 62 yea s, p=0.02), emale gende (p=0.005), and use o
immunosupp essi e medica ion (p=0.02). O he ac o s, such as BMI, como bidi ies, and d essing ype, we e no
s a is ically signi ican .
Conclusion: Age, gende , and immunosupp essi e he apy signi ican ly impac lowe limb skin g a su i al.
P eope a i e op imiza ion o a - isk pa ien s and ailo ed pe iope a i e managemen may imp o e g a ou comes.
Keywo ds: Lowe Limb; Skin G a ; G a Failu e; Wound Healing; Immunosupp essi e The apy; Recons uc i e
Su ge y
1. In oduc ion
Fo ea ing a a ie y o lowe limb lesions, such as bu ns, diabe ic oo ulce s, auma ic inju ies, and ch onic non-
healing ulce s, skin g a ing is s ill a undamen al componen o econs uc i e su ge y. Skin g a s a e essen ial o
egaining he unc ion and look o he inju ed limb because hey speed up wound closu e and encou age issue
egene a ion. G a ailu e isk is s ill a majo clinical conce n e en wi h imp o emen s in su gical me hods and
pos ope a i e ca e. Inc eased mo bidi y, delayed healing, mul iple su gical p ocedu es, ex ended hospi al s ays, and
highe heal hca e expenses can esul om g a ailu e, which is cha ac e ized as he pa ial o o al loss o he g a as
a esul o non-adhe ence, nec osis, o in ec ion. Nume ous pa ien - ela ed and p ocedu e- ela ed ac o s, as well as he
lowe limb, in luence he p e alence and de e minan s o ansplan ailu e. Because o hei dependen loca ion, which
makes hem mo e suscep ible o edema and enous conges ion, he lowe ex emi ies a e mo e suscep ible o g a
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1378-1383
1379
ailu e. G a p oblems a e also caused by inadequa e ascula i y, inc eased con amina ion isk, limb mobili y, and
exposu e o ex e nal s ess du ing he healing p ocess. A p ope ly p epa ed wound bed, su icien pe usion, in ec ion
con ol, immobiliza ion, and p ope pos ope a i e ca e a e all essen ial o g a success. Howe e , by in e e ing wi h
mic oci cula ion, angiogenesis, and cellula egene a ion, como bidi ies such diabe es melli us, pe iphe al a e y
disease, smoking, anemia, malnu i ion, and immunosupp ession se e ely educe g a ake. Pa ien s unde going lowe
limb econs uc ion equen ly ha e hese cha ac e is ics, especially in low- and middle-income na ions like Pakis an.
Pakis an has a disp opo iona ely high a e o ch onic wounds and lowe limb inju ies because o indus ial isks,
inadequa e diabe es managemen , ising a ic acciden s, and delayed access o specialized ca e. Acco ding o na ional
es ima es, diabe es melli us, a key isk ac o o oo ulce s and he need o skin g a ing, a ec s mo e han 16% o
Pakis an's adul popula ion.
I is well ecognized ha neu opa hy, ischemia, and immunosupp ession in diabe ic pa ien s hinde wound healing.
Lowe limb wound healing is made mo e di icul by he ising incidence o pe iphe al ascula disease in he elde ly
popula ion. The e is li le local da a on g a esul s and isk ac o s in spi e o conside able clinical load. In Pakis ani
li e a u e, he speci ic p oblem o skin ansplan ailu e—pa icula ly in he lowe limbs— emains unde s udied,
whe eas he majo i y o publica ions concen a e on wound ca e o diabe ic oo issues.
Fu he mo e, g a ing me hods, pos ope a i e p ocedu es, and ou come documen a ion a e inconsis en because o he
dispa i ies in su gical p ac ices be ween Pakis an's public and p i a e heal hca e acili ies. High a es o p oblems a e
caused by a numbe o ac o s ha a e mainly un epo ed, including inadequa e wound bed p epa a ion, poo pa ien
compliance, poo hygiene, and a lack o ollow-up ca e. Su gical esul s and pos ope a i e eco e y a e also in luenced
by sociocul u al ac o s, such as heal h illi e acy, gende di e ences in access o ca e, and inancial limi a ions. As a
esul , g a loss and ela ed p oblems a e mo e likely o occu in pa ien s who a e p esen la e in he cou se o he
disease o who s op ea men oo soon.
Nume ous ac o s, such as in ec ion, wound bed ischemia, g a ype and hickness, exposed endons o bone, ixa ion
me hod (su u ed s. s apled), and lack o use o adjunc s like nega i e p essu e wound he apy (NPWT), ha e been
ound o be p edic i e o g a ailu e in he lowe limbs wo ldwide. Howe e , because o a ia ions in in as uc u e,
pa ien cha ac e is ics, and esou ce a ailabili y, i is unclea whe he hese indings can be applied o he heal hca e
sys em in Pakis an. Es ablishing local epidemiological da a ha cha ac e izes he ex en o skin g a ailu e and
pinpoin s he mos pe inen isk a iables in ou con ex is impe a i e. This da a can be used o imp o e lowe limb
es o a ion esul s, c ea e s anda dized p ocedu es, and es ablish he apeu ic s anda ds.
To imp o e su gical decision-making and lessen he cos o epea ed su ge ies, i is essen ial o comp ehend he
p e alence and isk ac o s o skin g a ailu e in Pakis an. P eope a i ely iden i ying high- isk pa ien s enables he
adop ion o p e en a i e measu es, op imal medical condi ion op imiza ion, sui able counseling, and he selec ion o
he bes g a ing p ocedu es. Fo example, when cus omized o he pa ien 's isk p o ile, he use o NPWT, enhanced
hemos a ic con ol, in ec ion p ophylaxis, and limb immobiliza ion can g ea ly inc ease g a success a es.
Fu he mo e, local da a can help wi h aining and esou ce planning, pa icula ly a e ia y ca e hospi als ha handle
a la ge numbe o auma and econs uc i e cases.
The e o e, he pu pose o his s udy is o de e mine he main isk ac o s o lowe limb skin g a ailu e in Pakis ani
pa ien s as well as he p e alence o his condi ion. This s udy in ends o measu e he bu den o g a ailu e and iden i y
co ela ions be ween clinical, demog aphic, and su gical ac o s and ansplan ou comes by analyzing mul icen e
pa ien da a. The esul s will help su geons wi h isk assessmen and be e pe iope a i e ca e, in addi ion o adding o
he scan amoun o na ional li e a u e al eady in exis ence. Ul ima ely, he goal is o educe complica ion a es, imp o e
g a iabili y, and enhance he quali y o pa ien ca e in he ield o econs uc i e su ge y in Pakis an.
2. Me hodology
The s udy co e ed all pa ien s who needed skin g a ing o hei lowe limbs. Pe mission was ob ained om he
ins i u e's e hical e iew commi ee. De ails abou he pa ien a e eco ded, such as age, gende , and BMI. Diabe es
melli us (DM), hype ension, hype lipidemia, ischemic hea disease, cance , ulce s, auma, elec i e cases, and enous
insu iciency we e among he condi ions o which da a was ga he ed. Ana omical wound si e,
an icoagula ion/an ipla ele he apies, and immunosupp ession we e eco ded in he ansplan his o y. We looked a
he weigh -bea ing condi ion o he wound size a he ime o STSG placemen , 14 days a e STSG, and 45 days a e
STSG. P o en echniques we e used o pe o m skin g a s. All p ocedu es we e pe o med unde ei he gene al o
egional anes hesia, and as a p ecau ion, an ibio ics we e gi en. Depending on he su geon's judgmen , he pa ien s
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1378-1383
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we e ei he eleased wi h ea ly mobiliza ion o admi ed o he hospi al unde supe ision o h ee o se en days. A e
su ge y, he g a s we e examined on he i h day and hen e e y o he day un il he g a was emo ed en i ely.I mo e
han 80% o he skin g a s we e emo ed ollowing a clinical assessmen , he p ocedu e was conside ed success ul.
Mic oso Excel was used o da a en y. SPSS e sion 21 was used o s a is ical analysis. A pa ame ic - es was
employed o s a is ical analysis o assume a no mal dis ibu ion, and signi icance was de e mined using Fishe 's exac
uni a ia e analysis.
3. Resul s
Pa icipan s we e 28.5 ± 11.2 yea s old on a e age. The e we e 38 emales and 41 males among hem. In e ms o BMI
dis ibu ion, 29 pa ien s we e unde weigh , 18 we e o e weigh , 11 we e obese, and 21 had a no mal BMI.
Six y- wo pa ien s had mul iple g a s, whe eas se en een pa ien s ecei ed single g a s. Thi y- wo pa ien s had
enous insu iciency.
Diabe es melli us (62 cases) and hype ension (75 cases) we e he mos p e alen como bidi ies, ollowed by pe iphe al
ascula disease (9 cases) and ischemic hea disease (19 cases).
Thi een pa ien s epo ed using immunosupp essi e medica ions, while hi y- wo pa ien s epo ed using
an icoagulan s.
In e p e a ion: Al hough he s udy sample was young, he e we e se e al ch onic como bidi ies, especially diabe es and
hype ension, which a e known o hinde wound healing and may ha e an impac on Cance was he mos common
eason o g a ing (23 ins ances), ollowed by ulce s (16), auma (21), and elec i e cases (19). G a a ea anged om
0.16 o 8.1 cm², wi h a median o 0.92 cm². Nine g a s we e ull- hickness, while he majo i y 70 ins ances) we e spli -
hickness. In 20 cases, sponge d essings we e used, and in 59 cases, acuum d essings. In e ms o pos ope a i e ca e,
20 pa ien s we e immedia ely mobilized, while 59 pa ien s we e pu on bed es .
Table 1 Demog aphic de ails o he s udy pa icipan s
Age
28.5 ± 11.2
Gende
Male
41
Female
38
BMI
No mal
21
Unde wiegh
29
o e weigh
18
Obese
11
G a s
Single
17
Mul iple
62
Venous insu iciency
32
Como bidi ies
Diabe es
melli us
62
Hype ension
75
Ischemic
hea disease
19
Pe iphe al
ascula
disease
9
An icoagulan usage
32
Immunosupp essan
medica ion
18
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1378-1383
1381
In e p e a ion: The mos common me hods we e spli - hickness g a ing and acuum-assis ed closu e. In line wi h he
econs uc i e equi emen s o oncologic and auma ic lowe limb abno mali ies, cance and auma we e he mos
common causes o skin g a s.
Table 2 Repo ed e iology o lowe limb skin g a
Indica ion o lowe limb skin g a
Indica ion
o lowe
limb skin
g a
Cance
23
T auma
21
Ulce
16
Elec i e
case
19
A ea o g a
0.
92 cm2 (0.16–
8.1 cm2)
G a ye
Spli
hickness
70
Full
hickness
9
D essing
ype
Vacuum
59
Songe
20
Managemen
Bed es
59
Immedia e
mobiliza ion
20
Ou o he o al, 28 g a s ailed and 51 we e success ul. The median age o pa ien s wi h success ul g a s was 62 yea s,
which was lowe han he median age o pa ien s wi h ailu es (73 yea s, p = 0.02).
The dis ibu ion o gende s e ealed a signi ican co ela ion (p = 0.005), wi h a la ge pe cen age o success ul g a s
in males. The ailu e g oup used immunosupp essi e medica ions a signi ican ly g ea e a es (6 s. 1, p = 0.02).
The e we e no s a is ically signi ican co ela ions ound be ween o he ac o s, including ischemic hea disease (p =
0.07), diabe es melli us (p = 0.07), enous insu iciency (p = 0.19), BMI (p = 0.52), g a ype (p = 0.79), and d essing
ype (p = 0.11). In e p e a ion: G a ailu e was signi ican ly p edic ed by immunosupp essi e ea men , olde age,
and emale gende . Despi e hei lack, como bidi ies such as diabe es and IHD exhibi ed ends owa d signi icance,
indica ing po en ial he apeu ic ele ance.
Table 3 Compa ison o g a ou comes in s udy pa icipan s
Va iables
G a
success
51
G a
Failu e
28
P-
alue
Age (median)
62
73
0.02
Gende male: emale
32:23
9:15
0.005
IHD
8
11
0.07
Venous insu iciency
10
22
0.19
Pe iphe al ascula
disease
3
6
0.92
BMI (median)
30
42
0.52
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1378-1383
1382
Spli hickness skin
g a
42
13
0.79
Vacuum d essing
30
18
0.11
Diabe es
13
8
0.07
Immunosupp essan s
1
6
0.02
G a size
0.98
1.22
0.06
Acu e ope a ions
7
4
0.07
4. Discussion
The esul s o lowe limb skin g a s we e examined in his s udy in ela ion o demog aphic, clinical, and p ocedu al
pa ame e s. The esul s show ha he usage o immunosupp essi e medica ions, age, and gende all ha e a subs an ial
impac on ansplan su i al. The co ela ion be ween g a ailu e and ad anced age is in line wi h esea ch showing
ha poo healing in elde ly indi iduals is caused by dec eased ib oblas ac i i y, delayed epi helializa ion, and
impai ed angiogenesis (Mille e al., 2021). Compa ably, se e al s udies ha e iden i ied emale gende as a possible isk
ac o , pe haps as a esul o ho monal a ia ions ha impac ascula esponses and collagen o ma ion (Chen e al.,
2020).
In ou sample, immunosupp essi e ea men was ound o be a powe ul p edic o o ansplan ailu e. This is
consis en wi h da a showing immunosupp essan s, especially calcineu in inhibi o s and co icos e oids, educe
collagen deposi ion and cellula p oli e a ion, which comp omises g a ake (Ande son e al., 2019).
Como bidi ies include diabe es melli us and ischemic hea disease ended owa d an ele a ed isk o ailu e e en i
hey did no achie e s a is ical signi icance. Diabe es is known o p oduce neu opa hy and mic o ascula impai men ,
which hinde s he healing o wounds (Li e al., 2022). Spli - hickness skin g a s a e mo e common in p ocedu al aspec s,
which is indica i e o hei high ake a es and adap abili y o lowe limb econs uc ion (Pe ei a e al., 2021). The
s udy emphasizes he alue o p eope a i e op imiza ion, pa icula ly o olde and immunocomp omised pa ien s, and
he necessi y o ca e ully choosing which pa ien s should be immedia ely mobilized a he being placed on bed es . To
in es iga e modi iable pe iope a i e ac o s and o u he alida e hese indings, la ge mul icen e ials a e
necessa y.
5. Conclusion
This s udy emphasizes ha immunosupp essi e d ug use, ad anced age, and emale gende a e impo an p edic o s
o lowe limb skin g a ailu e. Como bidi ies such diabe es melli us and ischemic hea disease shown endencies
owa d wo se ou comes and a e none heless clinically ele an e en hough hey did no app oach s a is ical
signi icance. G a su i al in his coho was no co ela ed wi h p ocedu al pa ame e s such as d essing echnique o
g a ype. G a success a es may be inc eased by op imizing pa ien heal h be o e su ge y, especially in olde and
immunocomp omised pa ien s. To con i m hese esul s and imp o e pe iope a i e ea men echniques, la ge ,
p ospec i e ials a e necessa y.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Re e ences
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