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Page 10 of 13 Wilson et al. Plast Aesthet Res. 2025;12:8 https://dx.doi.org/10.20517/2347-9264.2024.135

and it also requires less analgesia, as the burn is completely grafted sooner and the donor site is smaller.
Furthermore, in the earlier stages, the Meek micrografts are covered with silk as a secondary dressing,
making dressing changes more tolerable and reducing the need for general anesthesia. This results in fewer
trips to the operating room for dressing changes, earlier mobilization, and earlier discharge. We are
increasingly combining Meek with two-stage dermal substitutes, allowing some areas to be temporized and
grafted at a later second stage when the neodermis has vascularized. This combination of Meek and a
dermal matrix/scaffold or other cell-based technologies such as CEA is gaining increasing interest [5,8,15] . The
early outcomes of long-term scarring are encouraging.

In our practice, we are seeing that the combination of Meek and a dermal regeneration template allows for a
robust reconstruction. These scars are less prone to contracture, with more elastic and pliable results
compared to Meek on a full-thickness wound bed. Our scar outcomes are comparable to those of
conventional meshed grafts with the same dermal templates; however, our present series is too small to have
statistical significance. A large series published by Tapking et al. in 2024 included 175 patients treated at a
German burns center. All patients with burns greater than 10% TBSA received Novosorb BTM, followed by
®
skin grafting using various techniques, including standard meshing and Meek. Of the 24 Meek patients, the
mean TBSA was 47.9% +/- 19%, with a mean take of 80.7 (+/-21.1%) at 10 days, which was not significantly
different to the BTM + traditional meshed graft patients .
[21]

Two other studies have evaluated the use of Integra for these injuries in a total of four patients, with injury
size ranging from 76% to 92% [13,22] . Of the four patients, three had initial application of Integra followed by
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Meek at a subsequent date, and one received a combination of Integra and a traditional meshed graft in
®
some anatomical areas, and Integra with Meek in others. For the latter patient, the Integra and traditional
®
®
mesh combination led to an 85% healing rate at 2-3 weeks, while the Integra and Meek combination
®
resulted in 45% healing at 2-4 weeks, ultimately requiring subsequent regrafting with meshed STSG in areas
[22]
with ongoing issues . The other three patients also reported varying degrees of healing, with one showing
75% re-epithelialization seen at four weeks, while another required a subsequent meshed graft due to
infection-related loss of Meek .
[13]
The concept of overgrafting split-thickness skin graft donor sites has been documented in the literature,
with the earliest mention by Thompson in 1960 . The aim of this practice is to reduce donor site healing
[35]
time, thereby decreasing the risk of morbidity, including donor site infection and hypertrophic scarring .
[36]
We have used Meek to overgraft donor sites when Meek is also used to graft the burn, primarily in patients
who may struggle with donor site healing, such as the very elderly or those with very large burns. There is
currently limited literature on the possible benefits of overgrafting donor sites with Meek, and we are still
evaluating our results - the practice was only mentioned in one Meek-related paper, which did not
specifically address the outcome .
[33]

Meek for smaller burns
We believe that the Meek technique is a valuable option for patients with smaller TBSA burns, particularly
in the elderly or comorbid patients at risk of poorer wound healing. In these patients, reducing donor size
and subsequently overgrafting the donor sites can help reduce healing time and pain - both factors known
to limit mobility and prolong the rehabilitation period. Additionally, in patients who are not fit for general