Punch grafts to treat lower limb intractable sores

Abstract

Lower limb recurrent ulcers, usually caused by prolonged decubitus, trauma, diabetes or burns, may not heal with conventional clinical or surgical treatment. Frequently, laminated skin grafts do not integrate with the recipient layer, and the only alternatives are neighbor microsurgical flaps. These have higher morbidity and create secondary defects, to be corrected with skin grafts, when fasciocutaneous or miocutaneous segments are removed for the treatment of the primary defect. We describe the non-conventional use of punch grafts in the treatment of lower limb ulcers, when conventional skin laminated graft failed, without the use of flaps. Since this is a very successful technique, its use should be considered as a valuable alternative for the treatment of recurrent lower limb ulcers. It is a simple and easy-learned technique that may be used by different surgeons, even in remote places without correct specialized hospital facilities.

Assessment of the effect of punch full-thickness skin grafting on wound epithelialization

“…Dostępna jest również opisana na podstawie pojedynczych przypadków metoda, w której do pobierania skóry do przeszczepu wykorzystywana jest sztanca dermatologiczna [25][26][27]. Jest to metoda prostsza oraz tańsza w porównaniu z przeszczepami dermatomowymi i przeszczepami punktowymi wykonywanymi przy zastosowaniu systemu próżniowego.…”

“…Terapia uciskowa zapobiega wstecznemu przepływowi krwi żylnej, a ponadto sprzyja przyjęciu się przeszczepu, co pobudza proces epitelializacji owrzodzenia. W pracach dostępnych w piśmiennictwie nie stosowano terapii uciskowej, co mogło wpływać na wydłużenie czasu gojenia owrzodzeń [25,26].…”

“…There is a method described on the basis of single cases in which a dermatological punch is used to collect the skin [25][26][27]. It is a cheaper method compared to a dermatome or epidermal transplant and easier to use.…”

“…Not only is it important for preventing the back flow of venous blood, yet it is also crucial for better acceptance of the graft and hence epithelialisation of the ulcer. No compression therapy was used in the studies that have already been published, which could have prolonged the healing time of the ulcer [25,26].…”

“…It is essential to treat the underlying condition to maintain proper blood supply to the skin. No compression therapy was used in the studies that have already been published, which could have prolonged the healing time of the ulcer [25,26].…”