Treatment of severe burns with widely meshed skin autograft and meshed skin allograft overlay

Abstract

A major factor limiting survival following extensive thermal injury is insufficient availability of donor sites to provide enough skin for the required grafting procedures. While 3:1 expanded mesh autograft have aided greatly in better utilization of available sites, a 6:1 or greater expanded mesh graft is often accompanied by significant loss of the graft. A technique has been developed in which widely meshed autograft (6:1 or greater) is covered by a 1.5 or 3:1 expanded mesh allograft to provide better take. Fourteen patients have been treated using this technique covering areas of 1 to 15% body surface area, and the results compared with the take and ultimate coverage of 3:1 expanded mesh autografts. The size of burn of these patients varied between 25% total/11% 3 degrees and 98% total/95% 3 degrees (average 58%/47%). Eleven procedures were done after excision to fascia, four after tangential excision, and the remaining seven grafts were placed on granulating wounds. The allograft used for overlay had been preserved by freezing and storage in liquid nitrogen. Epithelial outgrowth from the autograft was more rapid than from the allograft, but both types of graft took and became vascularized initially. There was an average of 99% autograft take and 95% allograft take. However, three patients subsequently had graft loss as a result of burn wound sepsis. The allografts gradually rejected 3 to 30 days post-grafting with the time of 50% loss averaging 14 days. Rejection of the allograft was not associated with acute inflammation or loss of autograft. The ultimate cosmetic appearance and function was acceptable in all. This new technique appears to offer significant advantages for the grafting of extensively burned patients with limited donor sites.