Page 26 - Read Online

Wilson et al. Plast Aesthet Res. 2025;12:8 https://dx.doi.org/10.20517/2347-9264.2024.135 Page 5 of 13

70, and one was a child. Information regarding patient comorbidities is summarized in Table 1, with a
median of 3 comorbidities per patient.

The median number of procedures was 2 (IQR2,3). The median time to first Meek graft was 8 days (IQR
7,15), with a median TBSA grafted of 12% (IQR 8.5,15.4). Two patients received a combination of Meek and
meshed grafts at the time of the first autograft. The median time to 95% healing was 62.5 days (IQR 26,130),
and the median length of hospital stay was 29 days (IQR 16,53). There was a high mortality rate in those
aged 70 years or older, with 4 out of 14 (29%) dying within 3 months of surgery.

Compared with Series C (n = 36), there was a statistically significant difference in median age between Series
B and C (71 vs. 43 years old, P < 0.0001), as shown in Figure 2. Patients with burns less than 20% TBSA
(Series B) underwent significantly fewer procedures than those with larger burns in Series C (median: 2 vs.
6.5 procedures, P < 0.0001). Although patients in Series B had a smaller TBSA requiring healing, their
median wound healing rate was slower than that of Series C (0.18 vs. 0.61 % TBSA healed per day, P <
0.0014).

Literature review
Of the 27 papers we reviewed, we found one randomized study, six retrospective cohort studies, sixteen case
series, and four case reports. The sample sizes of these studies ranged from 1 to 175 patients. The majority
(n = 14) focused exclusively on adults, while six examined only pediatric patients, and seven included both
age cohorts. As noted in Introduction, a comprehensive review of the outcomes associated with the
modified Meek technique for burn injuries has been recently published. The authors of that review noted
the absence of evidence on the use of Meek for small burns . In our literature search, we identified five
[27]
papers discussing the application of Meek in smaller TBSA injuries, one of which specifically explored its
®
use in combination with Novosorb Biodegradable Temporising Matrix (BTM) [21,23-26] . Additionally, two
studies evaluated the modified Meek technique in conjunction with an alternate dermal substitute, Integra
®
(Integra Life Sciences Corp., US), while another investigated its use with cultured epithelial allografts
(CEA) [5,13,22] .

Our review focuses on key areas for future innovation with Meek: its application in small burns, its
integration with dermal substitutes, and its impact on scar-related outcomes. A summary of the reviewed
papers is presented in Table 2. The studies included in the review varied in design and reported outcomes,
leading to heterogeneity in the results. Consequently, not all columns in the table are applicable to every
paper. WA “/” in the table denotes cases where a particular category does not apply to a given study.

DISCUSSION
When selecting skin graft techniques for patients with burn injuries, surgeons must consider multiple
factors, from donor site availability and patient preference, to time to healing, and both aesthetic and
functional outcomes. Innovative techniques such as Meek micrografting, and epidermal and dermal
substitutes play important roles in determining the most suitable approach for each patient. Historically,
there has been a general perception that the traditional Tanner meshed split-thickness skin graft produces
superior aesthetic results compared to the Meek split-thickness skin graft. However, based on our
experience, while the final appearance of Meek micrografts and meshed split-thickness grafts differs, neither
technique is definitively superior. Further analysis of our patient series is currently ongoing to evaluate this
observation in greater detail. One challenge associated with meshed grafts is that the actual expansion
achieved does not correspond directly to the intended expansion ratio. In practice, the expansion is often
significantly lower due to various factors, such as the loss of fragile graft pieces during meshing and the