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Wilson et al. Plast Aesthet Res. 2025;12:8 https://dx.doi.org/10.20517/2347-9264.2024.135 Page 3 of 13

[27]
larger TBSA burns, which has been covered in a recent review . In this paper, we aim to present our
experience with Meek since its introduction to our unit in 2011, focusing on its application for smaller
(< 20%) TBSA burns and considering the use and outcomes in combination with dermal substitutes.

METHODS
Patients who underwent skin grafting using the modified Meek technique at the Adult Burns Centre of
Chelsea and Westminster Hospital between 2011 and 2024 were retrospectively identified using theatre logs.
Burn cases of any TBSA were included if the Meek technique was used for either partial or complete
coverage of the burn. Data on patient demographics, operative details, and surgical outcomes were
manually retrieved from patient medical records and operation notes, with all information anonymized.
Statistics were performed using Microsoft Excel and GraphPad Prism (Version 10). The quality of the
healed grafts was assessed using the patient and observer scar assessment scale (POSAS), which assigns a
score from 1 to 10, whereby the closer the score to “1”, the more similar to normal skin the scar is felt to
be .
[28]

A systematic review of the literature on the modified Meek technique was conducted by two investigators
using Ovid, searching MEDLINE, Embase, and PubMed. The search strategy was as follows:

1. “Meek” OR “Meek micrograft” OR “Micrograft” AND;
2. “Burns” OR “Major Burns” OR “Burn Injuries” AND;
3. “Outcomes”.

Further references were identified using the snowballing technique. Papers evaluating non-human subjects
or written in languages other than English were excluded. A flow diagram of the process is demonstrated in
Figure 1.

Following a two-stage review process, a total of 27 papers were included in our literature review. Data were
extracted from these papers using a formal, standardized data extraction form in Microsoft Excel.

RESULTS
Demographics
A total of 76 patients were treated for burn injuries using the modified Meek technique at our hospital
between 2011 and 2024. Of these, 12 were excluded from our analysis due to incomplete records, resulting
in a final study population of 64 (series A). The overall median age was 53 years (IQR 39-73).

The mechanisms of injury were as follows: flame burn in 71%, scald in 16%, chemical in 2%, contact in 5%,
electrical in 3%, and oil in 3%. Burn depth varied: 19% full thickness, 3% deep dermal, 6% mid-dermal, 2%
superficial partial thickness, and 70% mixed depth. Among the mixed-depth burns, 42% had a full-thickness
component.

There were 29 patients requiring ICU-level care. The mortality rate among ICU patients was 7% (n = 2).
Seven patients were transferred to another unit and were therefore excluded from further analysis. One
additional patient was excluded due to unclear ICU admission details. Among the remaining 19 ICU
patients, the median length of stay was 36 days (IQR 19,44), and the median TBSA was 40% (IQR 10, 40).