Micropunch grafting for healing of refractory chronic venous leg ulcers

Background

Chronic venous ulcers are a serious problem for both patients and physicians. The CEAP classification (clinical manifestations (C), etiologic factors (E), anatomic distribution of disease (A), and underlying pathophysiologic findings (P)) for chronic venous disorders (CVD) was developed in 1994. Published papers on CVD use all or part of the CEAP. Micropunch grafts, which are a variation of skin grafts, have been used with great success in plastic surgery for both esthetic and reconstructive purposes. This study aimed to assess the outcomes of micropunch grafting in the treatment of chronic refractory venous ulcers.

Methods

Patients with chronic venous ulcers who did not respond to conservative treatment for more than 6 months were included in the study. All patients underwent ulcer coverage by micropunch skin grafts using a micrometer. The patients were discharged on the same day as the surgery. Micropunch skin grafts were manually counted per square centimeter intraoperatively and during follow-up using Dermlite Dermatoschope™ II Pro HR. Patient satisfaction was assessed by using a questionnaire.

Results

Twenty patients underwent the surgery. Most of the patients were middle-aged males. The ulcers were predominantly small- and medium-sized. The mean operation time was 167.00 ​± ​86.01 ​min. After 6 months, the survival rate of the planted micrografts was 84%. Three ulcers had graft loss and two patients had an infection at the ulcer site, which was managed conservatively. The patients were followed-up for 14 months.

Conclusion

Micropunch grafting is a useful and convenient method for the treatment of difficult venous ulcers and can be performed on an outpatient basis.