Search

Objective: Martorell hypertensive ischaemic ulcers are often misdiagnosed and can be a clinical and therapeutic challenge. Controversy exists regarding both their underlying triggers and the type of treatment that should be carried out. This study was designed to compare the effectiveness of punch grafting and conventional therapy in pain reduction. Method: A single-centre retrospective study was performed, including 40 patients with a clinical diagnosis of a Martorell ulcer or post-traumatic ulcer secondary to arteriolopathy in the elderly, who were treated with punch grafting (n= 24) or conventional medical treatment (n=16). Results: There was a statistically and clinically significant reduction in pain after punch grafting. The minimal overall reduction was of three points in visual analogue pain scores. Of the patients who received punch grafting, 80% reported a VAS pain score of 0 at the third follow-up, in contrast with the 44% (n=4) patients who were treated without punch grafting. The mean time to epithelialisation was 82.1 days in patients who received conventional treatment and 43.5 days in those who received punch grafts. Conclusion: Punch grafting is a simple, validated and cost-effective technique that can be performed on an outpatient basis, promotes wound healing and reduces pain. It may control pain and stimulate epithelialisation even if the wound does not present with optimum wound bed characteristics for graft taking. Pain reduction and faster epithelialisation are associated with improvements in patients' quality of life.

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.

El objetivo de este estudio fue analizar la seguridad y tolerancia de un calcetín protector cutáneo confeccionado con tecnología Regenactiv® en pacientes con dermatoporosis y/o cambios cutáneos por insuficiencia venosa crónica.Se realizó un estudio prospectivo en la consulta de heridas del Centro de Especialidades Periféricas Vicente Soldevilla entre noviembre y diciembre de 2018. Se incluyeron todos los pacientes que acudieron a la consulta de heridas que presentaban dermatoporosis en la piel de la pierna y/o alteraciones dérmicas por insuficiencia venosa crónica.El 89% (n=18) de los pacientes no presentaron eventos adversos, un único paciente (5%) presentó un evento adverso en forma de erosión. Otro paciente (5%) no pudo emplear el calcetín porque no se adaptaba al perímetro de su pierna.Un 48% (n=10) de los pacientes puntuaron la comodidad del calcetín con un 9 o 10, un 38% (n=8) entre un 7 y un 8, y sólo un 5% con un 6 sobre 10 en la escala Likert. El paciente que no pudo utilizar el calcetín de manera continuada, no valoró este ítem. El 90% (n=18) de los pacientes no manifestaron dolor durante el tiempo de utilización del calcetín. Un 10% (n=2) de los pacientes alcanzaron un nivel de dolor de 3-4 en la escala de EVA.El uso de un calcetín protector confeccionado con tecnología textil Regenactiv® por parte de pacientes con dermatoporosis y/o afectación cutánea secundaria a insuficiencia venosa crónica produce escasos efectos adversos y es bien tolerado. Además, puede ser empleado bajo dispositivos de compresión terapéutica.

Posttraumatic ulcers secondary to age-related arteriolosclerosis may be included in the clinic-histopathological spectrum of the Martorell hypertensive ischemic ulcer. Histologically, they both present occlusive subcutaneous arteriolosclerosis. Considering these similarities, they could benefit from the same treatment.The authors present an 84-year-old white female who had a painful 9-cm x 4-cm ulcer of the central inner aspect of her left leg. The ulcer had developed 2 months prior after mild trauma, with good response to early and sequential punch grafting, combined with single-use negative pressure wound therapy and compression therapy. Pain reduction was obtained from the first punch grafting session. To achieve complete epithelialization 16 weeks after the first punch grafting procedure, 2 more sessions were necessary.Early punch grafting is an effective technique for pain control and healing promotion in Martorell ulcers. Punch grafting, which may be performed in an outpatient setting, is well tolerated by patients and may be repeated several times if necessary.