Effectiveness of Punch Grafting in Promoting Healing and Reducing Pain in Hard-to-Heal Leg Ulcers

Abstract

Approximately 20% of chronic leg ulcers remain recalcitrant despite treatment of underlying factors and best standard of wound care. This study aimed to evaluate the effectiveness of partial-thickness punch grafting in promoting healing and reducing pain in patients with chronic, hard-to-heal leg ulcers of various causes. In this single-centre, retrospective cohort study, 93 patients were treated between January 2016 and December 2024, with follow-up at 1, 3, 6 and 12 months. The primary outcome was complete wound healing, while secondary outcomes included pain reduction and wound surface changes. At 12 months, 78/88 analysed patients (88.6%) achieved complete healing of the target ulcer. Pain levels improved substantially, with the proportion of pain-free patients increasing from 17.6% at baseline to 76.3% at 6 months. Donor site complications were minimal (6.5%) and cosmetic outcomes were excellent. Recurrence after 12-month follow-up occurred in only 9% of healed ulcers within 12 months. These results confirm that partial-thickness punch grafting is a highly effective and minimally invasive technique for treating hard-to-heal leg ulcers, delivering durable healing, rapid pain relief and low morbidity. This study provides new long-term data supporting the broad clinical utility of punch grafting across diverse ulcer types.

Keywords: chronic leg ulcer; hard‐to‐heal leg ulcer; punch graft; punch grafting; recalcitrant leg ulcer; skin grafting.