Pinch Grafts Research Articles

Pinch Grafts Versus Second Intention Wound Healing for Mohs Micrographic Surgery Defects Below the Knee: A Prospective Randomized Trial.

The surgical management of leg wounds following skin cancer extirpation is challenging. Pinch grafting (PG) is a technique that has been rarely described in the reconstruction of acute surgical wounds. The purpose of this study was to evaluate whether PG resulted in faster healing times for below the knee wounds following Mohs micrographic surgery (MMS) when compared with second intention healing (SIH). This was a prospective randomized trial of patients with post-Mohs micrographic surgical wounds of the lower extremity who were randomized either to receive pinch grafts or to heal by second intention. Patients were followed through a combination of in-person and virtual visits until their wounds were completely reepithelialized. Median time to wound healing was 36 days in the PG group versus 56 days for the SIH group, representing a 56% improvement in healing time. There were no differences in complications between the 2 groups with trends toward decreased rates of pain and infection in the PG group. PG is an effective simple method to hasten the healing of lower extremity wounds following MMS.

"SCULP" study: The benefits of skin graft pellets on the pain of sickle cell leg ulcers (SCLU).

Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.

Pinch grafting: An alternative skin grafting technique

Pinch grafts are a useful and cost-effective technique as an adjunctive consideration for closure of sub-acute or chronic lower extremity wounds. In our institution, we have used this technique on numerous patients with appropriately prepared wounds amenable to skin grafting. Pertinent factors include patients with adequate arterial flow, absence of infection, metabolic stability of diabetes mellitus, cardiac disease, renal disease and acceptable nutrition. The procedure adds minimal morbidity, allows for primary closure of the donor site, and can be done in an outpatient setting under local anesthesia. This technique is efficient, economical, and useful on a wide variety of wounds with good results.

Foot Wounds and the Reconstructive Ladder.

Background:Foot soft tissue coverage represents a challenge to reconstructive surgeons due to a lack of donor sites for this specialized skin. This glabrous tethered thick skin is designed to withstand weight bearing stress and is hard to replace. The limited arch of rotation of foot local flaps contributes to further difficulties. In this study, we share our experience in foot soft tissue loss coverage using techniques tailored to each wound presentation.Methods:This case series presents eight patients with wounds of the plantar and dorsal surfaces of the foot, heel, and ankle. Closure techniques were selected and planned based on wound presentation and comorbidity status.Results:Patients’ mean age at surgery was 61 years. Etiologies of wounds include trauma, frostbite, diabetic ulceration, malignancy, pressure ulcer with osteomyelitis, and necrotizing infection. Coverage techniques included split and full-thickness skin graft, medial plantar arch pinch graft, cultured epithelial autograft, Hyalomatrix wound device, EpiFix tissue matrix, pedicle flap, and free rectus flap. Complete soft tissue coverage was achieved in each case within reasonable postoperative periods, and ambulation was preserved and/or restored.Conclusions:Foot soft tissue reconstruction is challenging and should be planned carefully due to the required specialized skin replacement. Primary closure should be considered first and attempted if possible. Technique escalation in accordance with the reconstructive ladder should be undertaken based on wound etiology, presentation, amount and nature of tissue loss, available resources, and surgeon experience.

The Reverdin Graft: The Forgotten Skin Transplant.

This article describes a series of four patients for whom a Reverdin graft was performed. The Reverdin graft, also known as a pinch graft, is a method to promote epithelialization for superficial wounds. The intervention is minimally invasive with a short learning curve. The procedure and its advantages and disadvantages are discussed in this case series. This pinch graft is a widely accepted, minimally invasive intervention to accelerate the epithelialization of wounds.

Pyruvate Kinase Deficiency and Leg Ulcers

We report a family with a new pyruvate kinase (PK) variant in which leg ulcers have been present in four of the five affected homozygous family members, but not in any of the unaffected individuals. The propositus, an 18-yr-old boy, suffered from recurrent crises of hemolytic anemia and leg ulcers. A splenectomy was performed and the leg ulcer was treated un-successfully with a pinch graft. Studies ondialyzed hemolysates showed that the enzyme was kinetically abnorma, being almost entirely resistant to activation by fructose diphosphate. THE THERMOSTABILITY OF THE ENZYME WAS MODERATELY DECREASED, AND THE ELECTROPHORETIC MOBILITY WAS NORMAL. One may speculate that the development of leg ulcers in some kinships with PK deficiency may be related to variants of PK which exert unusual effects on the rheologic properties of the red cell in vivo.

Reverdin pinch grafts for surgical closure after removal of nonmelanoma skin cancer lesions of the leg

Background: Surgical closure after removal of nonmelanoma skin cancer on the leg can be challenging. Objective: Reverdin pinch grafting is an old skin transplant approach to treat leg ulcers. We present our experience using Reverdin pinch graft to close leg surgical defects following excision of nonmelanoma skin cancers. Patients and Methods: This was a retrospective study of 35 patients with medium-large sized defects with a median ± standard deviation of 20 ± 2.7 mm. Pinch grafts harvested from the thigh were used to cover the surgical leg defects with a 6-year follow-up period. Results: The average healing time after pinch grafting was 4 weeks ± 1.12 weeks. Ten patients (28.6%) had a failure of one or two single pinch grafts. There was no hypertrophic or keloid scarring in any grafted patients. Wound infection occurred in two patients (5.7%) and postoperative hemorrhage in only one patient (2.8%). Basal cell carcinoma arose in one patient (2.8%). Conclusion: Reverdin pinch graft technique is an easy and effective closure option for medium-large surgical defects of the leg after nonmelanoma skin cancer excision.

Hair-follicle Transplant Into Chronic Ulcers: A New Graft Concept

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers.

Trasplante de folículos pilosos en úlceras crónicas: un nuevo concepto de injerto

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers.

A prospective analysis of pinch grafting of chronic leg ulcers in a series of elderly patients in rural Cameroon

BackgroundChronic leg ulcers (CLUs) pose serious public health concerns worldwide. They mainly affect the elderly population. Pinch grafting (PG) could be used to treat a variety of CLUs. However, in Cameroon, there is scarce data on the outcome of PG of CLUs in elderly patients in rural hospitals where most of these patients seek for medical attention and where clinicians rely on unconventional wound dressing methods to treat CLUs. Our objective was to describe the outcome of PG of CLUs in elderly patients in rural Cameroon.MethodsThis was a prospective study conducted in a rural hospital of North West Cameroon. From February 2015 to January 2016, comprehensive historical and clinical data were collected per elderly patient who presented with a chronic leg ulcer necessitating PG. PG was done using a simple procedure and each patient followed up for 8 months. Outcome was described in terms of ulcer healing and pain and donor site complications.ResultsOur series included 13 patients: 8 males (61.54%; 95% CI: 31.58–86.14) and 5 females (38.46%; 95% CI: 13.86–68.42) aged from 69 to 88 years (mean: 77.54 ± 5.70 years). Three patients (23.08%; 95% CI: 5.04–53.81) had associated co-morbidities. All the ulcers were unilateral with durations ranging from 7 to 41 months (mean: 19.46 ± 11.03 months). The ulcers ranged in size from 9.0 to 38.1 cm2 (mean: 17.66 ± 8.35 cm 2). We registered one (7.69%; 95% CI: 0.19–36.03) graft rejection. Concerning the other ulcers, ten (83.33%; 95% CI: 51.59–97.91) had healed after 12 postoperative weeks while 2 (16.67%; 95% CI: 2.09%–48.41) had healed after 14 postoperative weeks and the mean healing time was 12.33 ± 0.78 weeks. Patients with healed ulcers had reduced ulcer site pain from the immediate postoperative period but there was no significant difference in the mean pain scores before and after graft (6.77 against 4.23, p = 0.13). These ulcers remained healed after 8 postoperative months. Each donor site had healed 2 weeks after PG. Donor site problems were minimal and included hypopigmentation.ConclusionThe outcome of PG of CLUs in our series of older patients was satisfactory. This finding does not discount the role of conservative therapy, but we encourage clinicians in rural Cameroon to consider PG over long-term unconventional conservative therapy in the elderly.

Skin grafting for venous leg ulcers

Venous leg ulceration is a recurrent, chronic, disabling condition. It affects up to one in 100 people at some time in their lives. Standard treatments are simple dressings and compression bandages or stockings. Sometimes, despite treatment, ulcers remain open for months or years. Sometimes skin grafts are used to stimulate healing. These may be taken, or grown into a dressing, from the patient's own uninjured skin (autografts), or applied as a sheet of bioengineered skin grown from donor cells (allograft). Preserved skin from other animals, such as pigs, has also been used (xenografts). To assess the effect of skin grafts for treating venous leg ulcers. For this update we modified the search strategies and conducted searches of The Cochrane Wounds Group Specialised Register (searched 27 July 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); Ovid MEDLINE (2008 to July Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 26, 2012); Ovid EMBASE (2008 to 2012 Week 29); and EBSCO CINAHL (2008 to 26 July 2012). We did not apply date or language restrictions. Randomised controlled trials (RCTs) of skin grafts in the treatment of venous leg ulcers. Two review authors independently undertook data extraction and assessment of study quality. For this update of the review, we identified one new trial, bringing the total to 17 trials (1034 participants) - all of which were generally at moderate or high risk of bias. In 12 trials participants also received compression bandaging.Eleven trials compared a graft with standard care in which no graft was used. Two of these trials (102 participants) compared a dressing with an autograft; three trials (80 participants) compared frozen allografts with dressings, and two trials (45 participants) compared fresh allografts with dressings. Two trials (345 participants) compared tissue-engineered skin (bilayer artificial skin) with a dressing. In two trials (97 participants) a single-layer dermal replacement was compared with standard care.Six trials compared alternative skin grafting techniques. The first trial (92 participants) compared autografts with frozen allograft, a second (51 participants) compared a pinch graft (autograft) with porcine dermis (xenograft), the third (110 participants) compared growth-arrested human keratinocytes and fibroblasts with placebo, the fourth (10 participants) compared an autograft delivered on porcine pads with an autograft delivered on porcine gelatin microbeads, the fifth trial (92 participants) compared a meshed graft with a cultured keratinocyte autograft, and the sixth trial (50 participants) compared a frozen keratinocyte allograft with a lyophilised (freeze-dried) keratinocyte allografts.Significantly more ulcers healed when treated with bilayer artificial skin than with dressings. There was insufficient evidence from the other trials to determine whether other types of skin grafting increased the healing of venous ulcers. Bilayer artificial skin, used in conjunction with compression bandaging, increases venous ulcer healing compared with a simple dressing plus compression. Further research is needed to assess whether other forms of skin grafts increase ulcer healing.

Mini-Abdominoplasty in Burn Reconstruction

The excision of excessive fat and subcutaneous tissue in the infraumbilical region, also known as "mini-abdominoplasty, " can be used to harvest skin for burn reconstruction. The resultant full-thickness grafts are less prone to contracture than split-thickness grafts. They are particularly useful in areas where mobility is important, such as the neck and areas overlying major joints. It allows a single-stage reconstruction with little donor site morbidity and favorable long-term functional outcomes. Multiple other donor sites have been reported, most commonly the groin and small pinch grafts on the trunk, but they provide only small amounts of skin when compared with the abdomen. The authors report 12 cases of patients who were treated for sequelae of burns with full-thickness abdominal skin grafts that were procured by mini-abdominoplasties for the sole purpose of obtaining the skin. The mini-abdominoplasty in this series was found to be an effective, safe technique that provides large amounts of full-thickness skin for reconstruction. While the size of the grafts varied with age and size of the abdomen, up to 40 × 15 cm can be obtained in adults. The donor site complications are rare but most commonly include seromas and dehiscence of the wound.

A modified, improved, easy and fast technique for split-thickness skin grafting

Large nonhealing ulcers and wounds frequently pose a great therapeutic challenge to clinicians and often require skin grafting. Various skin grafting methods are available to cover large skin defects that fail to epithelize. These methods include the use of small pinch grafts, full-thickness punch grafts, large-sized full-thickness grafts and split-thickness grafts. Large-sized full-thickness and split-thickness skin grafting requires expertise to produce cosmetically acceptable results and prevent cobblestoning, unlike small pinch and full-thickness punch grafts. To describe a modified technique of split-thickness skin grafting that can be considerably faster than alternative methods. We describe a method for split-thickness skin grafting using tumescent anaesthesia at the donor site and an electrodermatome and a polyurethane membrane without sutures at the site of the skin defect. Since 1997, we have practised a modified, improved, quick and easy split-thickness skin grafting method to cover large skin defects at the extremities. Complete healing is usually achieved 4-6 weeks after the split-thickness skin transplantation, and long-term results are aesthetically successful. We provide a sophisticated modified split-thickness skin graft procedure that has been practised for many years and provides cosmetically acceptable results while saving time.

Pinch grafting of chronic leg ulcers: a retrospective analysis of 104 patients with 169 ulcers

To compare healing rates of inpatients and outpatients with chronic leg ulcers treated with pinch grafting and to define which of these patients would benefit most from the therapy. This retrospective analysis reports the healing rates of 104 patients with 169 ulcers treated with pinch grafting during 1997-2007 at the Department of Dermatology, Tampere University Hospital. These relate to 17 outpatients with 18 pinch-grafted ulcers and 95 inpatients with 151 ulcers. Nine ulcers (50%) in the outpatient and 95 (62.9%) in the inpatient group healed completely. Median healing times were five and eight weeks for the outpatient and inpatient groups respectively. For the sample as a whole, 61.5% of the ulcers healed. This retrospective study found that pinch grafting is an efficient method of treating chronic leg ulcers, with an overall healing rate over 60%. Patients who complied with compression therapy were most likely to benefit from this therapy.

Evaluation of postage stamp skin grafting in the treatment of non healing leg ulcers

Surgical intervention is necessitated when medical management fails in leg ulcers. 30 cases of non healing leg ulcers present for more than 4 weeks were subjected to postage stamp grafting. The grafts were harvested by split thickness skin or pinch grafting techniques. These grafts were cut into postage stamp graft size of 2-3 sq.cm and placed over the prepared ulcer beds. 17(56.70%) ulcers were vascular (venous 14, arterial 3) in origin, while trauma, diabetes and leprosy were responsible in 6(20%), 3(10.0%) and 2(6.70) cases respectively. 2(6.7%) cases had combined etiologies. In 21(70%) cases, ulcers healed completely (Grade I); 7(23.7%) cases healed initially but subsequently broke down (Grade II) while in rest of 2(6.7%) cases, ulcers never healed (Grade III). Success rate was 70%. Two cases of lepromatous leprosy with ENL and varicose veins never healed. Postage stamp skin grafting is a reliable, simple, and easy to master surgical procedure for the management of nonhealing skin ulcers.

Modified unna boot and pinch grafting for chronic non-healing venous leg ulcer

Venous ulcers cause considerable morbidity. A 45-year-old man reported with non healing ulcer since 15 years. Patch tests revealed multiple sensitivity. Infection was first controlled with antibiotics and antiseptics. Dressing with modified Unna’s boot made with zinc oxide 40% and glycerine paste 60% resulted in formation of healthy granulation tissue. Pinch grafting was subsequently done to promote epithelization. We recommend the use of Unna’s paste instead of more expensive synthetic and occlusive and semi occlusive dressing to promote granulation tissue and pinch grafting after bed is ready to hasten epithelization.

VS17P ‘PINCH SKIN GRAFTING – THE FORGOTTEN AID IN WOUND HEALING’– TEN YEAR EXPERIENCE IN A RURAL HOSPITAL

Purpose To assess the efficacy of ‘Pinch Grafting’ on chronic ulcers, many which are vascular in origin (Arterial or Venous). Retrospectively and prospectively our experience will be presented. Methodology Over the last ten years chronic leg ulcers (15 cases a year) have been grafted in North West Regional Hospital, Mersey Campus, Tasmania. Age of these patients extends from 56 to 91 with a median age of 79. Most of these cases are grafted as outpatients and some of them done in wards, while the patient is admitted for other comorbid problems. Pinch grafts are done invariably with local anaesthetic. Pricking the anesthetized area (donor area) with a 22 needle a disc of 2–3 mm skin is tented and sliced by a no 20 blade, keeping tangential to skin surface. Discs are placed on the floor of prepared ulcers 4–5 mm apart. Many cases remain ambulant. Results 95% of the grafts take on 1st attempt and another 3% on the second attempt. No patient had any limitation for their comorbid problems. It was very easy to do: most junior staff of the team can do the procedure successfully. Conclusion Pinch skin grafts have been used for many of these patients with encouraging results. Pinch Grafting is a cost effective tool for healing chronic ulcers. 1 Factors influencing wound healing are multiple. 2 No particular dressing material is outstanding. 3 Pinch graft for chronic ulcers is a very practical and effective treatment. 4 Patient acceptance is high. 5 Very cost effective. 6 Can be given to GPs to use it as a primary care tool.

Evolution of full-thickness and pinch skin allografts evaluation at COBB 500 hybrids after immunotolerance induction in the thirteenth day of embryonic stage.

The purpose of this experiment was the macroscopic evaluation of the evolution of the allogenic skin grafts, evolution made through two surgical techniques (full-thickness skin grafts and pinch grafts) on COBB 500 hybrids. There have been used 20 birds aged four weeks and they have been separated in two groups: a control group (n=10) and an experimental group (n=10) to which, on day thirteen of the embrionary development, has been inoculated a concentrate of mature lymphocytes from the donor bird of skin grafts (hybrid Ross), with the aim of offering immunotolerance. The subjects have been monitored daily during the first five days after transplant and then, every two or three days for the full-thickness skin grafts and every two days for the pinch grafts, looking at the macroscopic characteristics of the transplanted tissue, among the most important being: color, aspect and adherence to the bed of the skin graft, as well as the aspect of the sides of the wound.

Guidelines for the treatment of arterial insufficiency ulcers

1. Co-chaired panel 2. University of Utah, Salt Lake City, UT 3. University of Texas, San Antonio, TX 4. Sinai Hospital/Johns Hopkins Medical Institutions, Baltimore, MD 5. GKT School of Medicine, King’s College, London, UK 6. University of Texas Health Science Center at Houston, TX 7. Sequoia Hospital, Redwood City, CA 8. Maricopa Medical Center, Phoenix, AZ 9. Tufts-New England Medical Center, Boston, MA 10. Southampton University Hospitals Trust NHS, Southampton, UK 11. Penrose–St. Francis Health Services, Colorado Springs, CO 12. Beverly Surgical Associates, Beverly, MA 13. Saint Francis Memorial Hospital, San Francisco, CA 14. Northbay Center for Wound Care, Vacaville, CA, and 15. University of California, San Francisco, CA

(43) Management of stasis ulcers by pinch graft

(43) Management of stasis ulcers by pinch graft