Interest of punch skin grafting for the treatment of painful ulcers.
Skin leg ulcers are chronic painful wounds. The treatment of these ulcers is crucial for patients because pain has a significant impact on their daily lives. The analgesic effect of punch skin grafting (PSG) for the treatment of painful ulcers is not well described. The objective of the study is to assess the level of pain in patients with an ulcerated wound and to see if there is an analgesic effect of PSG.


METHODS
A single-center, non-interventional study conducted in hospitalized patients with one or several ulcer(s) of any type and which has been painful for more than six weeks. Pain was assessed before, the day after a PSG and then on the way out of hospital by a questionnaire and a numeric pain rating scale. Permanent pain and pain peaks were identified.


RESULTS
Forty-one patients were included (23 men and 18 women) with a mean age of 73±21 years, 36% (n=15) with arterial ulcers, 36% (n=15) with venous ulcers, 12% (n=5) with necrotic angiodermatitis, 12% (n=5) with mixed ulcers and 4% (n=2) with "other ulcers" (due to infection and use of hydroxycarbamide). On day 1 of PSG, patients showed an improvement in terms of permanent pain (77%, n=24/31) and pain peaks (90%, n=37/41) respectively and 90% (n=28/31) and 95% (n=39/41) on the last day at hospital. Reduction in the use of strong opioids was found in 13 patients (81%).


CONCLUSIONS
Punch skin grafting is a simple and validated treatment, which can reduce or eliminate pain related to ulcers. It has an effect on permanent pain and pain peaks. Its efficiency is particularly demonstrated on venous ulcers and mixed ulcers but also initially painful ulcers such as necrotic angiodermatitis or arterial ulcers.
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France. Electronic address: caroline.fourgeaud@aphp.fr.
C
C
Fourgeaud
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
G
G
Mouloise
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
U
U
Michon-Pasturel
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
S
S
Bonhomme
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
I
I
Lazareth
Service de dermatologie, plaies et cicatrisation, hôpital Rothschild, 5, rue Santerre, 75012 Paris, France.
S
S
Meaume
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
P
P
Priollet
D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D001158:Arteries; D005260:Female; D006760:Hospitalization; D006801:Humans; D007871:Leg Ulcer / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain; D059408:Pain Management / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D014647:Varicose Ulcer / Q000503:physiopathology / Q000601:surgery
Douleur; Greffe cutanée en pastille; Pain; Punch skin grafting; Ulcer; Ulcère