Pinch grafting in combination with microperforations on the ulcer bed: an optimal symbiosis for the treatment of hard-to-heal ulcers: a case series.

OBJECTIVE: Hard-to-heal ulcers, particularly venous ulcers, often fail to heal with standard treatments. Pinch grafting is an effective therapy, though its success may be limited by poor ulcer bed vascularisation. This case series introduces a novel modification-microperforations in the ulcer bed to enhance graft uptake. METHOD: Patients with hard-to-heal leg ulcers (average duration seven years) underwent this technique. Microperforations were made with a 4mm punch before placing pinch grafts, followed by negative pressure therapy (PICO 7 Single Use Negative Pressure Wound Therapy System; Smith+Nephew, UK). RESULTS: This case series describes the treatment of three patients (average age 68.3 years). All ulcers healed completely within an average of 154.3 days, with no hospitalisations. CONCLUSION: This technique shows promise as a simple, effective alternative for improving outcomes in hard-to-heal ulcers, especially in cases with compromised vascularisation.