Meek Micrografting for Full-thickness Hand Burns in High TBSA Burn Patients

Abstract Introduction Full-thickness hand burns are uniquely challenging. Split-thickness sheet skin grafting is the current gold standard, however, requires large donor sites – impractical or impossible in high total body surface area (TBSA) burns. Additionally, necessary immobilization to prevent shear introduces rehabilitation challenges. Meek micrografting, comprised of many discontinuous, several-millimeter skin squares, theoretically allows near-immediate motion in any direction, easily conforms to complex shapes, and can be expanded in up to a 9:1 ratio. We hypothesized Meek grafting would allow earlier hand motion while maximizing use of little available harvest sites in high TBSA burn patients. Methods Meek micrografting to the hand was performed in seven high TBSA burn patients presenting to our academic Level 1 trauma and burn center. Burn characteristics, graft take, time of therapy initiation, and range of motion were recorded. Results Five males and two females average full-thickness TBSA of 32.2% (range 4% to 56%) with hand involvement were treated with Meek micrografting. Average hand burn dimension was 125 cm2. Three 2:1 ratio meek grafts were used per hand. Average donor site was 54 cm2. Average graft take at evaluation five days postoperatively was 95%. Compared to sheet grafting, mobility initiation was reduced from 10 to 5 days. Long-term (6 month) range of motion, patient reported outcomes, and revision rates were equivalent to sheet grafting. Conclusions Meek micrografting is an effective treatment method for full-thickness hand burns. Compared to sheet grafting, the technique reduces donor site requirements, allows early therapy, and long-term functional outcomes appear equivalent. Applicability of Research to Practice Preliminary results demonstrate that Meek micrografting is a safe, effective, and possibly superior coverage method for hand burns in the high TBSA patient. Funding for the study N/A.