Abstract
Lower limb recurrent ulcers, usually caused by prolonged decubitus, trauma, diabetes or burns, may not heal with conventional clinical or surgical treatment. Frequently, laminated skin grafts do not integrate with the recipient layer, and the only alternatives are neighbor microsurgical flaps. These have higher morbidity and create secondary defects, to be corrected with skin grafts, when fasciocutaneous or miocutaneous segments are removed for the treatment of the primary defect. We describe the non-conventional use of punch grafts in the treatment of lower limb ulcers, when conventional skin laminated graft failed, without the use of flaps. Since this is a very successful technique, its use should be considered as a valuable alternative for the treatment of recurrent lower limb ulcers. It is a simple and easy-learned technique that may be used by different surgeons, even in remote places without correct specialized hospital facilities.
Highlights
Lower limb deep ulcers usually do not heal, regardless the cause, and in most occasions are related to diabetes, trauma or burns
We describe the unconventional use of punch grafts for skin transplantation, as a safe, simple and useful alternative to skin grafts, without the inconveniences of laminated partial skin grafts
After using a tight shoe, he developed a deep and extensive ulcer at the region, with partial exposure of calcaneous tendon (Figure 4). He was submitted to non-surgical treatment with different dressings, without healing
Summary
Lower limb deep ulcers usually do not heal, regardless the cause, and in most occasions are related to diabetes, trauma or burns. This physiological response to trauma is not adequate to bigger ulcers, since it causes incomplete closure of the defect and/or covering with fragile epithelium, that usually harbors new ulcers, infection, and in rare cases, development of squamous cell carcinoma, as it is observed in Marjolin ulcers[4] The treatment of these lesions, when clinical management is unsatisfactory, usually is the use of laminated partial graft skin. After using a tight shoe, he developed a deep and extensive ulcer at the region, with partial exposure of calcaneous tendon (Figure 4) He was submitted to non-surgical treatment with different dressings, without healing.
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