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.
Pain control in patients with hard-to-heal wounds is a challenge for clinicians. Pain intensity may depend on the wound aetiology and is mainly associated with arterial and Martorell leg ulcers. However, venous leg ulcers (VLU) and other types of wounds can also be painful and have a high impact on a patient's quality of life (QoL).1
Punch-grafting is a traditional technique to enhance wound healing, and has been associated with significant pain reduction.2, 3, 4 Punch grafting is a method of obtaining thin split-thickness skin grafts (STSG) containing epidermis and papillary dermis. STSG are obtained under a local anaesthetic with a punch, curette or surgical blade and are placed directly on the wound bed. The donor site is normally the thigh, which heals by secondary intention. The procedure can be performed in an outpatient setting.2,3
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