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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.

Resumen: Antecedentes y objetivos: El Wound-QoL es un cuestionario validado para medir la calidad de vida en pacientes con heridas crónicas, que fue desarrollado originalmente para su uso en alemán.El objetivo de este estudio fue traducir el cuestionario Wound-QoL para su uso en la práctica clínica y estudios de investigación en España, así como validar esta versión. Materiales y métodos: Se realizaron dos traducciones independientes del Wound-QoL, directa e inversa, a partir de la versión original en alemán, seguidas de un consenso de expertos sobre las versiones resultantes. Después de su perfeccionamiento se realizó un estudio piloto y posteriormente el estudio de validación. Resultados: Se incluyó un total de 115 pacientes. La edad media fue de 69,5 (DE 14,5) años, y el 60,0% eran mujeres. La versión española del Wound-QoL mostró una excelente consistencia interna (índice alfa de Cronbach > 0,8 en todas las escalas). El análisis factorial dio como resultado las mismas escalas que la versión original. Se objetivaron características satisfactorias de la distribución de la puntuación global y de las subescalas. La validez de constructo y la validez convergente con otros resultados (calidad de vida genérica, tasa de curación) fueron satisfactorias. La gran mayoría de los pacientes consideraron que el cuestionario era una herramienta sencilla y factible. El tiempo medio necesario para completar el cuestionario fue de 5 minutos. El 99,1% de los participantes consideraron que las preguntas eran fáciles de entender y el 94,7% declaró que personal. Conclusiones: La versión española del Wound-QoL muestra una excelente validez en la práctica clínica. Por lo tanto, puede ser recomendada para su uso tanto en la rutina clínica como en los ensayos. Abstract: Background and aims: The Wound-QoL is a validated and feasible questionnaire for measuring disease-specific health-related quality of life in chronic wounds, originally developed for use in German.The objective of this study was to translate the Wound-QoL for use in clinical care and in clinical trials in Spain and to validate this version. Materials and methods: Two independent fourth- and back translations of the Wound-QoL from the original German version were conducted, followed by an expert consensus of the resulting versions. After refinement, the final tool was piloted in N = 10 patients and then used in the validation study. Results: A total of 115 patients were recruited. Mean age was 69.5 (SD 14.5) years, 60.0% were female. The Spanish version of Wound-QoL showed high internal consistency (Cronbach's alpha > 0.8 in all scales). Factor analysis resulted in the same scales as the original version. There were satisfactory distribution characteristics of the global score and the subscales. Construct validity and convergent validity with other outcomes (generic QoL, healing rate) were satisfactory. The vast majority of patients considered the Wound-QoL a simple and feasible tool. Mean time needed for completing the questionnaire was 5 minutes. Overall, 99.1% of the participants found it easy to understand the questions and 94.7% stated that the questionnaire suits the personal situation. Conclusions: The Spanish version of the Wound-QoL shows good validity in clinical practice. It can be recommended for use in clinical routine and trials.

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.

Objective To document the efficacy of a combined therapeutic strategy in achieving rapid wound healing in patients with long-standing ulcers. Materials and methods Outpatients with hard-to-heal venous leg ulcers were included in an interventional, prospective, single-arm, mono-centre study and treated with autologous punch grafting, TLC-NOSF dressing and multi-type compression therapy. The primary outcome was the percentage of healed wounds by week 12. Secondary outcomes included time-to-reach wound closure, wound area reduction, treatment acceptability and safety. Results From November 2018 to October 2019, 42 patients with 51 ulcers were included (23 males, 70.6±40.8 years old, with multiple comorbidities). Despite poor wound healing prognosis at baseline (47% of recurrent ulcers, with a mean duration of 15 months and a mean area of 12.6cm2), wound healing was achieved in 47 ulcers (92%) after a mean period of treatment of 25±13 days. A relative wound area reduction>75% was also reached in three additional ulcers by the last evaluation visit. No adverse event related to the procedure was reported throughout the study period. The associated treatment were very well tolerated and accepted by the patients. Conclusions The evaluated procedure induced fast re-epithelisation of the treated ulcers. Based on our experience, this simple and successful reparative strategy may be considered as an interesting option in the treatment of venous leg ulcers of poor prognosis.

BACKGROUND AND AIMS: The Wound-QoL is a validated and feasible questionnaire for measuring disease-specific health-related quality of life in chronic wounds, originally developed for use in German. The objective of this study was to translate the Wound-QoL for use in clinical care and in clinical trials in Spain and to validate this version. MATERIALS AND METHODS: Two independent fourth- and back translations of the Wound-QoL from the original German version were conducted, followed by an expert consensus of the resulting versions. After refinement, the final tool was piloted in N=10 patients and then used in the validation study. RESULTS: A total of 115 patients were recruited. Mean age was 69.5 (SD 14.5) years, 60.0% were female. The Spanish version of Wound-QoL showed high internal consistency (Cronbach's alpha>0.8 in all scales). Factor analysis resulted in the same scales as the original version. There were satisfactory distribution characteristics of the global score and the subscales. Construct validity and convergent validity with other outcomes (generic QoL, healing rate) were satisfactory. The vast majority of patients considered the Wound-QoL a simple and feasible tool. Mean time needed for completing the questionnaire was 5minutes. Overall, 99.1% of the participants found it easy to understand the questions and 94.7% stated that the questionnaire suits the personal situation. CONCLUSIONS: The Spanish version of the Wound-QoL shows good validity in clinical practice. It can be recommended for use in clinical routine and trials.

Las heridas crónicas disminuyen la calidad de vida de los pacientes que las padecen, incidiendo significativamente en su estado de salud y agravando su pronóstico general. La elevada incidencia y prevalencia de las úlceras en pierna, así como su alta cronicidad y recidiva, suponen un impacto psico-socio-sanitario elevado, con un alto gasto sanitario y una importante carga personal, familiar y social asociadas. La cicatrización de estos defectos representan un reto terapéutico para el personal sanitario, tanto en el primer eslabón asistencial como en hospitales.La cobertura de las heridas crónicas con microinjertos cutáneos en sello es una técnica eficiente, con muy buenos resultados. Disminuye los tiempos de cicatrización y los costes del proceso, especialmente si se realiza de manera ambulatoria. Es una técnica sencilla, beneficiosa per se para la epitelización por la cantidad de factores de crecimiento, células y otras moléculas que de los pequeños fragmentos de piel, se liberan sobre el lecho de las heridas. Otro de los beneficios que podemos atribuir a los microinjertos autólogos en sello es su efecto analgésico desde las primeras horas de su colocación.

Objectif La greffe en pastille est une technique largement utilisee dans notre pratique quotidienne. Elle peut accelerer l’epithelialisation des ulceres de jambe veineux (UJ). Compte tenu des resultats cliniques tres positifs observes lorsque nous traitions les UJ avec des pansements a base de TLC- NOSF (UrgoStart) associes a un systeme de compression a deux bandes (UrgoK2), nous avons concu un essai clinique ouvert pour evaluer de facon objective et independante, l’effet de ce protocole de soin sur la cicatrisation de ces plaies chroniques traitees par des greffes en pastille. Methodes Cinquante patients ambulatoires pour lesquels une greffe en pastille a ete realisee pour traiter tout ulcere de jambe veineux non infecte, meme en phase de detersion, ont ete inclus. Une evaluation clinique et des photographies ont ete realisees toutes les 2 semaines pendant une periode de 12 semaines maximum ou jusqu’a epithelialisation complete. Les pansements et les bandes de compression ont ete changes une fois par semaine. Resultats Une analyse intermediaire a ete menee sur 25 des 50 patients inclus. La taille mediane des plaies etait de 12,7 cm2 et leur anciennete etait de 83 semaines. Tous les patients analyses (âge moyen 72,7 ans ) ont cicatrise en 30 jours (mediane, extremes : 14 a 72 jours). Les resultats finaux sur les 50 patients inclus seront presentes. Discussion L’utilisation combinee presentee accelere la cicatrisation des ulceres de jambe veineux traites par des greffes en pastille. Les tres bons resultats cliniques, sont conformes a ceux d’une analyse retrospective portant sur les 3 dernieres annees avec cette procedure dans notre departement clinique.