A Retrospective Analysis Into the Effect of Punch Grafts in Patients With Chronic Ulcers of the Lower Leg

Background Chronic lower leg ulcers affect approximately 2% of adults in Western countries and are associated with significant pain, impaired quality of life and substantial healthcare costs. Effective pain management, which often includes opioid analgesics, is critical but complicated by adverse outcomes, particularly in frail elderly populations. Punch grafting, a minimally invasive technique involving the transfer of small skin sections to the ulcer, is increasingly used to promote healing and pain relief. Objectives To retrospectively evaluate the impact of punch grafting on pain scores and analgesic use in patients with chronic lower leg ulcers treated at Erasmus Medical Center, Rotterdam. Methods Retrospective recruitment between 2018 and 2023. Pain scores were assessed using the Numeric Rating Scale (NRS) at baseline and 6 weeks posttreatment, and analgesic use was documented. Ulcer reduction was visually assessed from clinical photographs, and healing rates were categorized. Statistical analyses included the Wilcoxon signed‐rank and McNemar's tests for paired comparisons. Results The median NRS pain score decreased significantly from 5.5 at baseline to 1.5 at 6 weeks ( p < 0.001). Opioid use declined from 52% at baseline to 33% posttreatment ( p < 0.001) and 30% of patients no longer required any analgesics. Complications were minor, primarily small infections and donor‐site issues. Photographic assessment showed complete wound healing in 7% of patients. Conclusions These findings suggest minimal invasive punch grafting as an effective intervention for reducing pain and opioid dependency in chronic ulcer patients while promoting healing. Prospective studies and randomized controlled trials are needed to refine patient selection criteria and compare punch grafting with other interventions. Punch grafting holds promise as a valuable option in managing painful chronic ulcers.