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Wilson et al. Plast Aesthet Res. 2025;12:8 https://dx.doi.org/10.20517/2347-9264.2024.135 Page 11 of 13

anesthetic, the reduced donor site required allows procedures to be performed under local anesthesia, which
would otherwise be intolerable without general anesthetic.

At present, there is no strong published evidence supporting the use of Meek for burns < 20% TBSA.
However, an ongoing intrapatient randomized controlled trial in the Netherlands is evaluating the
outcomes of Meek micrografting vs. mesh grafting for deep dermal/full-thickness burn injuries < 20%
TBSA. This study aims to reduce interpatient and wound variability by using both techniques on the same
patient with two wounds of similar depth, size, and location . We eagerly await the results of this trial.
[34]

It is also worth noting that although the majority of papers focus on the modified Meek technique in adults,
it has also been successfully used in pediatric patients. A total of eleven studies present outcomes for
pediatric patients with TBSA ranging from 5% to 92%, with time to satisfactory healing varying from 7 to 28
days [5,10,11,13-16,22,25,26] . One study that randomized 40 pediatric patients to either Meek or traditional meshed
grafts found that Meek grafts had a higher graft take rate than meshed skin grafts [84.25% (60-100) vs. 71.5%
(20-95)], with a shorter mean time to epithelialization [Meek 27.11 (14-70) days vs. Mesh: 33.5 (16-100)
days]. Additionally, the Meek patient group showed more favorable POSAS scores, both for the patient
(Meek mean 3.17, mesh mean 4.2) and observer (Meek mean 2.89, mesh mean 4.1). All these outcomes were
statistically significant . Minimizing donor sites in children is important, particularly as younger children
[25]
[37]
have a tendency to develop pathological scarring, which can lead to prolonged morbidity in the future .
In our series of 64 patients, we evaluated the role of the modified Meek technique for burn patients with a
range of TBSAs. We emphasize the importance of considering this technique, which is already accepted for
larger burn injuries, for patients with < 20% TBSA burns. The Meek technique allows for smaller donor sites
and promotes safe, effective, and timely wound healing, using the same expansion ratio as conventional
meshed grafts. Furthermore, the secondary silk dressing reduces the risk of wound desiccation, a common
issue with conventional skin grafts at higher expansion rates.

We have summarized the current published evidence on the use of the modified Meek technique and
discussed innovations and developments based on our series, including the combination of Meek with a
dermal substitute to achieve robust reconstructions with improved aesthetic and functional outcomes.

Our study has limitations. We focus on novel applications of Meek, such as for smaller burns and in
combination with dermal templates. Due to the relatively recent introduction of Meek in these areas, our
sample sizes for these cohorts are correspondingly smaller. Additionally, as our center began collecting
POSAS data only from the second half of the study, the sample size for the data (n = 13) was limited. We
continue to build upon these cohorts, which will help further strengthen the validity of future research.

Meek is emerging as a safe and easily effected technique not only for massive burns injuries, but also for
smaller TBSA burns, in both adults and children, with and without dermal regeneration templates and spray
cell technologies. We anticipate seeing Meek gain popularity for treating smaller TBSA burns, in
combination with dermal templates and keratinocyte cells, and look forward to more evidence supporting
overgrafting of donor sites with Meek.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the design of the study and performed data analysis, review of literature
and interpretation: Wilson E