- Email: [email protected]
“Punch grafting in post-surgical wounds”
Accepted Manuscript “Punch grafting in post-surgical wounds” Elena Conde-Montero, PhD, Laura Pérez Jerónimo, Alicia Peral Vázquez, Lorena Recarte Marín, Pablo Ernesto Sanabria Villarpando, Pablo de la Cueva Dobao, PhD PII:
S0190-9622(19)30354-8
DOI:
https://doi.org/10.1016/j.jaad.2019.02.060
Reference:
YMJD 13238
To appear in:
Journal of the American Academy of Dermatology
Received Date: 6 February 2019 Accepted Date: 17 February 2019
Please cite this article as: Conde-Montero E, Pérez Jerónimo L, Peral Vázquez A, Recarte Marín L, Sanabria Villarpando PE, de la Cueva Dobao P, “Punch grafting in post-surgical wounds”, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/j.jaad.2019.02.060. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
ACCEPTED MANUSCRIPT 1
Type of article: surgical pearl
2
Title of the article:“Punch grafting in post-surgical wounds”
Key words:
5
Punch grafting
6
Skin grafting
7
Post-surgical wound
8
Chronic ulcer
9
SC
4
RI PT
3
Authors
11
Elena Conde-Montero, PhD. Department of Dermatology, Hospital Universitario
12
Infanta Leonor y Virgen de la Torre, Madrid.
M AN U
10
13 14
Laura Pérez Jerónimo. Centro de Especialidades Vicente Soldevilla, Madrid.
15 16
Alicia Peral Vázquez. Centro de Especialidades Vicente Soldevilla, Madrid.
17
20 21
TE D
19
Lorena Recarte Marín. Centro de Especialidades Vicente Soldevilla, Madrid
Pablo Ernesto Sanabria Villarpando. Hospital Italiano de Buenos Aires
EP
18
Pablo de la Cueva Dobao, PhD, Chief of Service. Department of Dermatology,
23
Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid.
24
AC C
22
25
Corresponding autor: Elena Conde-Montero, PhD. Department of Dermatology,
26
Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid.
27
([email protected]).
28 29 30
Total number of photographs:2
31
Source(s) of support: none
32
Conflicting Interest : none
2
ACCEPTED MANUSCRIPT
Skin tumors usually occur in sun exposed areas. If direct closure after
34
removal is not possible, the defect can be reconstructed with a flap or
35
graft. Another option is to plan a secondary intention closure. This
36
alternative is common in locations such as scalp or leg, or when part
37
of a flap or graft becomes necrotic. Punch grafting may enhance this
38
healing by secondary intention. It is a simple technique, which may
39
be performed in the consultation room, and which, in addition to
40
promoting epithelialization, reduces pain. Therefore, it is very well
41
accepted by the patient. To obtain these small dermo-epidermal
42
fragments we can use a punch, scalpel or curette. The procedure is
43
performed under local anaesthesia in the donor site, usually the
44
thigh, and we do not go deeper than the papillary dermis. We know
45
that we are at the appropriate depth when we find a point-sized
46
bleeding after obtaining each graft. The small grafts are placed
47
directly on the wound bed. Both donor site and recipient site may be
48
covered with alginate calcium sheets. Local pressure and
49
immobilization the first three days after the procedure is essential for
50
graft taking. Superficial wounds in the donor site heal by secondary
51
intention. Dressing changes in the recipient site should be spaced as
52
far apart as possible until complete epithelialization is obtained and,
53
in each dressing change, minimal cleansing should be performed.
54
Complete healing may be achieved in few weeks as in this post-
55
surgical scalp wound (Figure 1 and 2).
AC C
EP
TE D
M AN U
SC
RI PT
33
3
ACCEPTED MANUSCRIPT 56
References:
57
RI PT
58
59
SC
60
M AN U
61
62
66
67
68
69
70
EP
65
AC C
64
TE D
63
4
ACCEPTED MANUSCRIPT References:
72
Figure 1: Post-surgical scalp wound secondary to basall cell
73
carcinoma excision covered with punch grafts.
74
Figure 2: Complete epithelialization at week 3 after the procedure.
AC C
EP
TE D
M AN U
SC
RI PT
71
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
S0190-9622(19)30354-8
DOI:
https://doi.org/10.1016/j.jaad.2019.02.060
Reference:
YMJD 13238
To appear in:
Journal of the American Academy of Dermatology
Received Date: 6 February 2019 Accepted Date: 17 February 2019
Please cite this article as: Conde-Montero E, Pérez Jerónimo L, Peral Vázquez A, Recarte Marín L, Sanabria Villarpando PE, de la Cueva Dobao P, “Punch grafting in post-surgical wounds”, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/j.jaad.2019.02.060. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
ACCEPTED MANUSCRIPT 1
Type of article: surgical pearl
2
Title of the article:“Punch grafting in post-surgical wounds”
Key words:
5
Punch grafting
6
Skin grafting
7
Post-surgical wound
8
Chronic ulcer
9
SC
4
RI PT
3
Authors
11
Elena Conde-Montero, PhD. Department of Dermatology, Hospital Universitario
12
Infanta Leonor y Virgen de la Torre, Madrid.
M AN U
10
13 14
Laura Pérez Jerónimo. Centro de Especialidades Vicente Soldevilla, Madrid.
15 16
Alicia Peral Vázquez. Centro de Especialidades Vicente Soldevilla, Madrid.
17
20 21
TE D
19
Lorena Recarte Marín. Centro de Especialidades Vicente Soldevilla, Madrid
Pablo Ernesto Sanabria Villarpando. Hospital Italiano de Buenos Aires
EP
18
Pablo de la Cueva Dobao, PhD, Chief of Service. Department of Dermatology,
23
Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid.
24
AC C
22
25
Corresponding autor: Elena Conde-Montero, PhD. Department of Dermatology,
26
Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid.
27
([email protected]).
28 29 30
Total number of photographs:2
31
Source(s) of support: none
32
Conflicting Interest : none
2
ACCEPTED MANUSCRIPT
Skin tumors usually occur in sun exposed areas. If direct closure after
34
removal is not possible, the defect can be reconstructed with a flap or
35
graft. Another option is to plan a secondary intention closure. This
36
alternative is common in locations such as scalp or leg, or when part
37
of a flap or graft becomes necrotic. Punch grafting may enhance this
38
healing by secondary intention. It is a simple technique, which may
39
be performed in the consultation room, and which, in addition to
40
promoting epithelialization, reduces pain. Therefore, it is very well
41
accepted by the patient. To obtain these small dermo-epidermal
42
fragments we can use a punch, scalpel or curette. The procedure is
43
performed under local anaesthesia in the donor site, usually the
44
thigh, and we do not go deeper than the papillary dermis. We know
45
that we are at the appropriate depth when we find a point-sized
46
bleeding after obtaining each graft. The small grafts are placed
47
directly on the wound bed. Both donor site and recipient site may be
48
covered with alginate calcium sheets. Local pressure and
49
immobilization the first three days after the procedure is essential for
50
graft taking. Superficial wounds in the donor site heal by secondary
51
intention. Dressing changes in the recipient site should be spaced as
52
far apart as possible until complete epithelialization is obtained and,
53
in each dressing change, minimal cleansing should be performed.
54
Complete healing may be achieved in few weeks as in this post-
55
surgical scalp wound (Figure 1 and 2).
AC C
EP
TE D
M AN U
SC
RI PT
33
3
ACCEPTED MANUSCRIPT 56
References:
57
RI PT
58
59
SC
60
M AN U
61
62
66
67
68
69
70
EP
65
AC C
64
TE D
63
4
ACCEPTED MANUSCRIPT References:
72
Figure 1: Post-surgical scalp wound secondary to basall cell
73
carcinoma excision covered with punch grafts.
74
Figure 2: Complete epithelialization at week 3 after the procedure.
AC C
EP
TE D
M AN U
SC
RI PT
71
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT