Punch grafting for pain reduction in hard-to-heal ulcers

Abstract

Objective: Punch-grafting is a traditional technique to enhance wound healing, which has been associated with significant pain reduction. There are few studies measuring pain reduction after punch grafting, our study was designed to measure this outcome. Method: Patients with hard-to-heal wounds treated with punch grafting were included in a single centre prospective study. Wound pain intensity was measured using a Visual Analogue Scale (VAS) at baseline (before the procedure) and at three time points after the procedure. Punch grafting was performed in an outpatient setting. Patient demographic data, wound aetiology and percentage of graft take were recorded. Results: A total of 136 patients were included (62 men and 74 women). Mean age was 60±35 years and 51 (38%) had venous leg ulcers (VLU), 29 (21%) had postoperative wounds, 15 (11%) Martorell ulcers, 15 (11%) traumatic wounds, four (3%) arterial ulcers and 22 ‘other’ ulcers. Of the patients, 31 (23%) did not present with painful ulcers and, after punch grafting, all of them remained painless; 16 (12%) patients obtained >70% pain reduction, whereas 86 (63%) patients achieved pain suppression. Pain suppression did not depend on the percentage of graft take. Conclusion: Punch-grafting is a simple, technique that not only promotes wound healing but also reduces pain. It can also be performed on an outpatient basis. Further studies should be performed to achieve a better understanding of this beneficial finding. Declaration of interest: The authors have no conflicts of interest to declare.

Bayesian Regression Model for a Cost-Utility and Cost-Effectiveness Analysis Comparing Punch Grafting Versus Usual Care for the Treatment of Chronic Wounds

“…To promote graft taking, pressure and local immobilization must be maintained during the first days. However, graft taking also depends on other factors, such as the characteristics of the wound bed (granulation tissue, slough, and bacterial load) [10]. This technique is performed on an outpatient basis, but it is sometimes necessary to admit the patient to ensure immobilization compliance.…”

“…In our clinical practice, we have confirmed that even if the wound bed does not present with perfect conditions for grafting, punch grafts that do not successfully adhere release growth factors and cells that promote wound epithelialization and reduce pain. Punch grafting in painful ulcers may produce a striking early analgesic effect [8][9][10] and is therefore a technique that is very well accepted by patients.…”

“…The donor site heals by secondary intention, with minimal infection or bleeding risks. Alginate is commonly recommended as primary dressing to minimize the risk of bleeding in the first 48-72 h. In the long term, the donor area may present color changes, both hypo and hyperpigmentation [10].…”

“…The most-used type of thin split-thickness skin graft is the mesh graft obtained with dermatome; this technique requires sophisticated material and must be performed in the operating room with the patient under general or loco-regional anesthesia [7]. Punch grafting is another type of thin split-thickness skin graft, less aggressive and more simple than the mesh graft, which does not require the use of complex instruments [8][9][10] and can even be performed on an outpatient basis. Being carried out on an outpatient basis is interesting from an economic point of view, as it minimizes costs compared to hospital level implementation [11].…”

“…The literature reporting the clinical results of punch grafting on chronic wounds mainly consists of case series and case reports [8,[10][11][12][13][14][15][16][17][18][19], but comparative studies are scarce. To the best of our knowledge, only one study compared punch grafting to negative wound therapy for the treatment of postsurgical wounds after melanoma excision [20], but comparative studies in the field of chronic wounds are lacking.…”