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Jeha GM, Hill E, Taylor L, Davis M, Greenway HT, Kelley B. Pinch Grafting: A Systematic Review of Modern Perspectives and Applications in Dermatologic Surgery and Wound Healing. Dermatol Surg 2024:00042728-990000000-00761. [PMID: 38630594 DOI: 10.1097/dss.0000000000004199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Pinch grafting has experienced a resurgence in interest in recent years, stemming from its simplicity, safety, and potential in restoring tissue integrity. While historically employed for chronic nonhealing wounds, pinch grafts have shown promise following surgical procedures, particularly those involving the lower extremities. OBJECTIVE To systematically review the literature and present an updated overview of the current applications of pinch grafting. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In collaboration with a medical reference librarian, the PubMed, Embase, Scopus, and Web of Science databases were searched for studies reporting on the use of pinch grafting from 2000 onward. The references of each included article were also screened. RESULTS Ten articles met final inclusion criteria. In total, 300 patients underwent pinch grafting for treatment of skin ulceration, while an additional 35 cases were performed as an alternative to primary closure following skin cancer resection. Overall, pinch grafting was safe and well tolerated, with minimal adverse outcomes reported. CONCLUSION Pinch grafting is a safe, straightforward, and effective technique to promote the healing of chronic wounds. While the procedure shows early promise in emerging applications within dermatologic surgery, only about 10% of the reported cases involved this indication, reflecting a need for further research in this area.
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Affiliation(s)
- George M Jeha
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Emma Hill
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
| | - Laura Taylor
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
| | - Michael Davis
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
- Memorial Sloan Kettering Cancer Center, New York, New York
- Memorial Sloan-Kettering Cancer Center-Basking Ridge, Basking Ridge, New Jersey
| | - Hubert T Greenway
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
| | - Benjamin Kelley
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
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Ruiz-Salas V, Marron M, Urbano Alcaraz M, Garcés JR, Puig L. Pinch grafting: a unique application? J Wound Care 2021; 30:504-505. [PMID: 34121435 DOI: 10.12968/jowc.2021.30.6.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Veronica Ruiz-Salas
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Marron
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Urbano Alcaraz
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J R Garcés
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - L Puig
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Selva-Sevilla C, Conde-Montero E, Gerónimo-Pardo M. Bayesian Regression Model for a Cost-Utility and Cost-Effectiveness Analysis Comparing Punch Grafting Versus Usual Care for the Treatment of Chronic Wounds. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3823. [PMID: 32481604 PMCID: PMC7313055 DOI: 10.3390/ijerph17113823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 01/21/2023]
Abstract
Punch grafting is a traditional technique used to promote epithelialization of hard-to-heal wounds. The main purpose of this observational study was to conduct a cost-utility analysis (CUA) and a cost-effectiveness analysis (CEA) comparing punch grafting (n = 46) with usual care (n = 34) for the treatment of chronic wounds in an outpatient specialized wound clinic from a public healthcare system perspective (Spanish National Health system) with a three-month time horizon. CUA outcome was quality-adjusted life years (QALYs) calculated from EuroQoL-5D, whereas CEA outcome was wound-free period. One-way sensitivity analyses, extreme scenario analysis, and re-analysis by subgroups were conducted to fight against uncertainty. Bayesian regression models were built to explore whether differences between groups in costs, wound-free period, and QALYs could be explained by other variables different to treatment. As main results, punch grafting was associated with a reduction of 37% in costs compared to usual care, whereas mean incremental utility (0.02 ± 0.03 QALYs) and mean incremental effectiveness (7.18 ± 5.30 days free of wound) were favorable to punch grafting. All sensitivity analyses proved the robustness of our models. To conclude, punch grafting is the dominant alternative over usual care because it is cheaper and its utility and effectiveness are greater.
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Affiliation(s)
- Carmen Selva-Sevilla
- Department of Applied Economy, Facultad de Ciencias Económicas y Empresariales de Albacete, Universidad de Castilla La Mancha, Plaza de la Universidad 1, 02071 Albacete, Spain
| | - Elena Conde-Montero
- Department of Dermatology, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031 Madrid, Spain;
| | - Manuel Gerónimo-Pardo
- Department of Anesthesiology, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02006 Albacete, Spain;
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Franks PJ, Bosanquet N. Cost-Effectiveness: Seeking Value for Money in Lower Extremity Wound Management. INT J LOW EXTR WOUND 2016; 3:87-95. [PMID: 15866794 DOI: 10.1177/1534734604264864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article discusses the different methods of evaluating cost in relation to the outcomes of treatment, and reviews the evidence of cost-effectiveness (CE) in the management of chronic leg ulceration. In essence, the CE argument revolves around the need to demonstrate outcomes of treatment in relation to particular levels of financial input by the health providers. High CE allows for either the same number of patients to be treatedmore efficiently (at a lower cost) ormore patients to be treated for the same financial input. Areview ofmedical and nursing databases (Medline, Embase, and Cinahl) identified studies of CE of dressing materials (n = 8), use of compression therapy (n = 4), and other treatments (n = 2). In addition, 5 research groups have undertaken studies to evaluate the relative CE of different systems of care. Overall conclusionsare that modern wound dressings provide a more costeffective alternative to saline gauze, whereas the evidence relating to the use of tissue-engineered skin is less clear. The use of compression bandaging is substantially more costeffective when compared with a system of care where compression is not systematically offered. The systems that offer compression are not only cost-effective but also lead to reductions in absolute cost. The evaluation of CE is likely to become an ever-increasing part of wound care evaluation as we strive to achieve greater efficiency in the use of scarce health resources.
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Affiliation(s)
- Peter J Franks
- Centre for Research & Implementation of Clinical Practice, Faculty of Health & Human Sciences, Thames Valley University, London.
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Tricco AC, Cogo E, Isaranuwatchai W, Khan PA, Sanmugalingham G, Antony J, Hoch JS, Straus SE. A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types. BMC Med 2015; 13:90. [PMID: 25899057 PMCID: PMC4405871 DOI: 10.1186/s12916-015-0326-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complex wounds present a substantial economic burden on healthcare systems, costing billions of dollars annually in North America alone. The prevalence of complex wounds is a significant patient and societal healthcare concern and cost-effective wound care management remains unclear. This article summarizes the cost-effectiveness of interventions for complex wound care through a systematic review of the evidence base. METHODS We searched multiple databases (MEDLINE, EMBASE, Cochrane Library) for cost-effectiveness studies that examined adults treated for complex wounds. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed methodological quality using the Drummond 10-item methodological quality tool. Incremental cost-effectiveness ratios were reported, or, if not reported, calculated and converted to United States Dollars for the year 2013. RESULTS Overall, 59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types. CONCLUSIONS Our results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings. Please see related article: http://dx.doi.org/10.1186/s12916-015-0288-5.
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Affiliation(s)
- Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Elise Cogo
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Paul A Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Geetha Sanmugalingham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Jeffrey S Hoch
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Geriatric Medicine, University of Toronto, 200 Elizabeth Street, Suite RFE 3-805, Toronto, ON, M5G 2C4, Canada.
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