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Page 2 of 13 Wilson et al. Plast Aesthet Res. 2025;12:8 https://dx.doi.org/10.20517/2347-9264.2024.135

dermal templates.

Keywords: Meek micrografting, modified Meek technique, burns, dermal templates

INTRODUCTION
Various techniques are available for skin reconstruction following burn injuries; however, the application of
split-thickness skin grafts remains the most common. Harvesting a skin graft requires the surgeon to create
an additional skin defect, termed the donor site. This presents a significant challenge, particularly in patients
with large burns, where limited donor site availability may necessitate re-cropping the same donor site
multiple times . Such procedures can delay wound healing, as the surgeon must wait for the donor site to
[1,2]
heal before it can be re-harvested. In cases requiring a large donor site, this also increases morbidity,
resulting in greater acute pain and a larger long-term scar. For massive burns, a high expansion ratio for
skin grafts is desirable, which can be achieved through Meek micrografting.

Meek micrografting, a technique developed by Cicero Parker Meek in 1958, aims to produce reproducible
micromeshing of skin grafts, thereby reducing the donor site area required, using a device to facilitate the
[3]
process . However, the technique did not gain popularity at the time, possibly because it coincided with the
introduction of the Tanner meshed skin graft method in the 1960s, which was less technically demanding .
[4]
The Meek technique was reintroduced in 1993 as the modified Meek technique, following technical
advances that streamlined the process by Humeca. Since then, it has gradually gained popularity and is now
an established alternative to conventional meshed grafts for massive burns that require larger skin
expansion ratios [2,5-19] . The modified Meek technique enables exact expansion ratios of 1:2, 1:3, 1:4, 1:6, and
1:9, with minimal donor skin wastage. The Meek system produces 3mm square split-thickness micrografts
that can be easily transferred to a wound using silk backing fabric, at a predetermined expansion ratio . A
[1]
donor as small as 10% total body surface area (TBSA) can cover 90% of a TBSA burn with a 1:9 expansion
ratio, and a 60% TBSA burn can be covered relatively easily with an expansion ratio as low as 1:3, without
the need for re-cropping donor sites.

We recognize the role of the Meek technique in facilitating the healing of large burn wounds when there is
limited donor site availability [6,7,10,12,17-20] . Additionally, we are beginning to explore the potential of Meek
grafting for patients who are at risk of poor wound healing, including the elderly or those with
comorbidities such as diabetes and peripheral vascular disease, where donor site healing is an additional
challenge and smaller donor sites are desirable . We are starting to observe positive outcomes following
[2]
Meek micrografting in combination with two-stage skin substitutes, reporting favorable graft take and long-
term scarring outcomes [13,21,22] .

To date, the only published evidence focused solely on the use of Meek in smaller TBSA burns is our own
previously published work, which mentions a small early series where this technique was used in patients
[1]
with burns < 20% TBSA . There are, however, several papers where patients with burns < 20% TBSA are
included as part of a larger series of patients with a range of injury sizes, providing additional support for
the use of this technique in smaller injuries [21,23-26] .

In our practice, we are increasingly electing to use Meek for smaller TBSA burns. Our goal is to minimize
the size of donor sites in patients with thinner dermis, particularly among the elderly. We also consider the
wishes of patients who request the smallest donor sites possible while ensuring timely healing and
comparable scar outcomes. We recognize that a substantial body of literature exists on the use of Meek for