Fourgeaud C, Mouloise G, Michon-Pasturel U, Bonhomme S, Lazareth I, Meaume S, Priollet P
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
Service de médecine vasculaire, groupe hospitalier Paris - Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
J Mal Vasc. 2016 Sep;41(5):329-34. doi: 10.1016/j.jmv.2016.08.002. Epub 2016 Sep 3.
Skin leg ulcers are chronic painful wounds. The treatment of these ulcers is crucial for patients because pain has a significant impact on their daily lives. The analgesic effect of punch skin grafting (PSG) for the treatment of painful ulcers is not well described. The objective of the study is to assess the level of pain in patients with an ulcerated wound and to see if there is an analgesic effect of PSG.
A single-center, non-interventional study conducted in hospitalized patients with one or several ulcer(s) of any type and which has been painful for more than six weeks. Pain was assessed before, the day after a PSG and then on the way out of hospital by a questionnaire and a numeric pain rating scale. Permanent pain and pain peaks were identified.
Forty-one patients were included (23 men and 18 women) with a mean age of 73±21 years, 36% (n=15) with arterial ulcers, 36% (n=15) with venous ulcers, 12% (n=5) with necrotic angiodermatitis, 12% (n=5) with mixed ulcers and 4% (n=2) with "other ulcers" (due to infection and use of hydroxycarbamide). On day 1 of PSG, patients showed an improvement in terms of permanent pain (77%, n=24/31) and pain peaks (90%, n=37/41) respectively and 90% (n=28/31) and 95% (n=39/41) on the last day at hospital. Reduction in the use of strong opioids was found in 13 patients (81%).
Punch skin grafting is a simple and validated treatment, which can reduce or eliminate pain related to ulcers. It has an effect on permanent pain and pain peaks. Its efficiency is particularly demonstrated on venous ulcers and mixed ulcers but also initially painful ulcers such as necrotic angiodermatitis or arterial ulcers.
腿部皮肤溃疡是慢性疼痛性伤口。这些溃疡的治疗对患者至关重要，因为疼痛对他们的日常生活有重大影响。关于打孔植皮术（PSG）治疗疼痛性溃疡的镇痛效果描述不多。本研究的目的是评估溃疡伤口患者的疼痛程度，并观察PSG是否具有镇痛作用。
在住院的患有任何类型的一处或多处溃疡且疼痛超过六周的患者中进行了一项单中心、非干预性研究。通过问卷和数字疼痛评分量表在PSG前、PSG后一天以及出院时评估疼痛。确定了持续性疼痛和疼痛峰值。
纳入41例患者（23例男性和18例女性），平均年龄73±21岁，36%（n = 15）为动脉性溃疡，36%（n = 15）为静脉性溃疡，12%（n = 5）为坏死性血管炎，12%（n = 5）为混合性溃疡，4%（n = 2）为“其他溃疡”（由于感染和使用羟基脲）。在PSG第1天，患者在持续性疼痛（77%，n = 24/31）和疼痛峰值（90%，n = 37/41）方面分别有所改善，在出院最后一天分别为90%（n = 28/31）和95%（n = 39/41）。13例患者（81%）的强效阿片类药物使用减少。
打孔植皮术是一种简单且经过验证的治疗方法，可减轻或消除与溃疡相关的疼痛。它对持续性疼痛和疼痛峰值有作用。其疗效在静脉性溃疡和混合性溃疡中尤为明显，但对最初疼痛的溃疡如坏死性血管炎或动脉性溃疡也有效果。
