Clinical outcomes of punch-grafting for chronic leg and foot ulcers – A retrospective case series study

Abstract

Degree Project Thesis, Programme in Medicine. TITLE: Clinical outcomes of punch-grafting for chronic leg and foot ulcers – A retrospective case series study. Introduction Punch-grafting has been used at The Department of Dermatology since the mid 1990´s for hard to heal ulcers of the leg and foot. These medical conditions are rather common, especially in the elderly population, and the prevalence is expected to increase due to longer life expectancy. Therefore evaluating this treatment method is necessary, something that has not been completely done before. Aim The aim of this study was to evaluate the clinical outcome of punch-grafting as a treatment for hard to heal leg and foot ulcers. Methods A single-center retrospective case-series study was performed to investigate the frequency of complete wound closures within 3 and 12 months after treatment. Data on case-subjects were collected manually from patient charts at Sahlgrenska University Hospital, primary care facilities or other forms of health care providers in charge of follow-up. Patients treated with punch-graft for one or several leg or foot ulcers at the Department of Dermatology between January 2004 and September 2013 were included in the case-group. Results A total of 213 patients with 284 ulcers were included and the mean age was 73.2 ±13.6 years. At 3 months 18.7 % of the ulcers had healed and at 12 months 52.2 %. Mean time to healing was 136 days for all ulcers that healed and mean ulcer duration prior to punch-graft was 25 months. Analysis of possible correlation between ulcer duration before punch-graft and time to healing, patient age and time to healing and localization of the ulcer and time to healing had no significant result. Conclusions/Implications The healing rates in this study were somewhat lower than those in previous studies made on pinch-and punch-graft. Ulcers categorized as ”others” had the shortest time to healing, indicating that these might be the most suitable ulcers for punch-graft. Even so, it is hard making any conclusions regarding these results due to the study design and further research is required before determining the future of this treatment method. Key Words: Chronic ulcer, Foot ulcer, Leg ulcer, Skin transplantation, Wound healing