Pinch Grafting of Chronic, Treatment-resistant Leg Ulcers A simple Office Based Autograft

Background: Although office pinch grafting is not used very frequently today, it is still a feasible technique that has a role in managing small burns, neuroischemic and stasis ulcers. These small, full-thickness grafts have a reputation for not being as cosmetically appealing as split-thickness or synthetic-tissue grafts as they can leave a cobblestone appearance at both the donor and the recipient site; however, they are effective and can be performed in any setting.

Objective: The technique for pinch grafts has not changed over the years, but in this case series we show that the use of pinch grafts can have accelerated healing and visually acceptable outcomes. Furthermore, the combination of pinch grafts with modern skin substitutes can be used together to prepare the wound bed and improve visual outcomes.

Methods: Retrospective study of wounds treated at a single site in the University Hospital in Iceland. Cases collected from January 2014 – December 2017. Pinch grafting was done in the outpatient wound care clinic under local anesthesia. Patients were followed up until full closure. Some wounds received acellular fish skin to prepare the wound bed for improved graft take or had fish skin placed on top of the pinch graft to salvage failing grafts. Patients furthermore received standard debridement and wound cleaning and compression therapy per institutional guidelines.

Results: 10 patients with venous leg ulcers treated with pinch grafts. 8 patients had achieved full healing within 12 weeks. 2 patients had early signs of graft failure but responded to a salvaging covering with an acellular fish skin graft and went on to full healing.

Conclusion: Pinch grafting can be used successfully to treat chronic treatment resistant wounds in the office setting. Compared to split skin grafting it allows for an inexpensive and quick wound area reduction that can have a high take rate because of selective grafting of the healthiest areas of the wound. It can be used in combination with skin substitutes in larger wounds where closure with secondary intention alone would be too time consuming.