Pinch grafting

by Verónica Ruiz

PINCH GRAFTING: A SIMPLE TECHNIQUE THAT ALLOWS YOU TO TREAT COMPLEX SKIN INJURIES

I would like to start this post by thanking Dr Elena Conde, my colleague dermatologist at the Infanta Leonor Hospital in Madrid, and her team Laura Perez, Alicia Peral and Lorena Recarte for the training received during my stay in the Wound/Injuries unit of the Vicente Soldevilla health center.

Thanks to all of you, excellent professionals and people,  I was able to learn this technique and other important concepts related to the care of the wounds that I have now been able to apply in my daily clinical practice.

I will always remember you all with a lot of love!

What is the technique?

This technique was described for the first time in 1869 to treat chronic ulcers due to chronic venous insufficiency in inferior extremities and consists of the transplantation of small pieces of shaved superficial akin from an area of healthy skin or another area of damaged skin, by means of the use of scalpel blade and surgical forceps.

It is a simple, efficient and low cost technique, which is performed on an outpatient basis under local anesthesia.

Not only does it represent an excellent alternative to cure some chronic ulcers, but one of its main advantages is the significant decrease in local pain associated with the ulcer itself, which in most cases happens already in the first days after performing the technique.

Which patients are candidates for the use of this technique?

Seal grafts are used for the treatment of chronic ulcers, usually in legs, of different causes, however the most extensive experience in the literature refers to the treatment of ulcers in the context of chronic venous insufficiency, arteriolosclerosis (Martorell’s ulcer) and diabetic ulcers.

Initially, any patient with chronic ulcers and with an adequate blood supply to the tissues may be a tribute to the realization of this technique, although those patients with partial arterial obstruction, which would cause a blood risk difficulty, could not be considered good candidates for this technique.

How are the cures performed after the technique and what can the patient expect?

The clinical reviews after the technique are usually carried out twice a week, so that the progress of the epithelialization, the need for changes in the dressings and if the injury requires the realization of a second round of treatment can be assessed.

It is recommended, if possible, both the day of the performance of the technique and the subsequent cures, the patient should be accompanied.

Generally, the patient is instructed to perform a more strict immobilization during the first 3 days after the technique (to remain seated with the legs elevated most of the time, alternating with short walks at home), increasing in a way slow and progressive periods of wandering from the 4th day.

The patient usually feels fine and what is most gratifying for the patient is the important reduction in pain that previously the experienced because of the ulcer, experiencing a good relief already past the 2 first days after the treatment.

We have to take into consideration, that in some occasions and due to some circumstances related to the etiology of the ulcer and the medical context or history of every patient, it might be necessary to repeat the process various times during a period of time until a complete closure of the ulcer is achieved.

REFERENCES

  • Elena Conde Montero, Soledad Guisado Muñoz, Laura Pérez Jerónimo, Alicia Peral Vazquez, Juan Jesus Montoro Lopez, Celia Hocajada Reales et al. Martorell Hypertensive Ischemic Ulcer Successfully Treated With Punch Skin Grafting. Wounds 2018 Feb;30(2):E9-E12.
  •  Rut F Oien 1, Anders Håkansson, Bjarne U Hansen, Mats Bjellerup. Pinch grafting of chronic leg ulcers in primary care: fourteen years’ experience. Acta Derm Venereol 2002;82(4):275-8.
  •  Hjerppe A, Sane M, Huhtala H, Vaalasti A. Pinch grafting of chronic leg ulcers: a retrospective analysis of 104 patients with 169 ulcers. J Wound Care. 2010 Jan;19(1):37-40.
  • Atanu Biswas, Manish Bharara, Craig Hurst, David G Armstrong, Horacio Rilo. The micrograft concept for wound healing: strategies and applications. J Diabetes Sci Technol 2010 Jul 1;4(4):808-19.