Chong Si Jack, Choke Abby, Tan Bien-Keem
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
Burns. 2017 Aug;43(5):983-986. doi: 10.1016/j.burns.2017.01.030. Epub 2017 Apr 22.
The lack of autograft donor site is one of the greatest limiting factors for the treatment of extensive burn. Micrografting is an important revolution in burn surgery where autografts are cut into small pieces for wide and rapid coverage of burn wound. Our early experiences with the current standard micrografting technique were fraught with poor graft take as well being time and labor intensive. We have improvised our technique, where we combined the use of allograft to serve as a carrier for the micrograft. The objective of this paper is to share our experience in micrografting and several technical tips which had enhanced our micrografting results. The improvisation in our technique includes: (1) Single-stage 'micrograft-allograft sandwich method' where allograft served as a direct carrier for the micrografts. Micrografts were laid uniformly 1cm apart onto allograft sheets, creating a 1:9 expansion ratio. This technique replaced the original two stage method. (2) The use of the Meek device (Humeca, Netherlands) to prepare micrograft. The Meek device can rapidly produce 3mm micrografts for easy transfer with a fine forceps. (3) The use of slow-acting fibrin sealant to promote graft take and hemostasis. (4) A two-team approach for micrograft preparation where one team processes micrograft and another prepares the allograft sheets. This reduces the lag time between micrograft preparation and grafting, and reduces the overall surgery time. Micrografting remains an important treatment for major burn surgery. The aim of micro-allograft combination is to allow autografts re-epithelization under a reliable temporary skin coverage in a single stage procedure. A prospective study is warranted to measure the objective outcome of this renewed technique.
自体移植供区的缺乏是大面积烧伤治疗的最大限制因素之一。微粒植皮是烧伤外科的一项重要变革，即将自体皮切成小碎片以广泛快速覆盖烧伤创面。我们早期使用当前标准微粒植皮技术的经验充满了植皮成活率低以及耗时费力的问题。我们改进了技术，将同种异体皮用作微粒皮的载体。本文的目的是分享我们在微粒植皮方面的经验以及一些提高微粒植皮效果的技术要点。我们技术的改进包括：（1）单阶段“微粒皮-同种异体皮三明治法”，其中同种异体皮作为微粒皮的直接载体。微粒皮以1厘米的间距均匀铺在同种异体皮片上，形成1:9的扩展比例。该技术取代了原来的两阶段方法。（2）使用Meek装置（荷兰Humeca公司）制备微粒皮。Meek装置可以快速制作3毫米的微粒皮，便于用精细镊子转移。（3）使用长效纤维蛋白密封剂促进植皮成活和止血。（4）微粒皮制备采用双组方法，一组处理微粒皮，另一组准备同种异体皮片。这减少了微粒皮制备和植皮之间的延迟时间，并缩短了总体手术时间。微粒植皮仍然是大面积烧伤手术的重要治疗方法。微粒皮与同种异体皮联合的目的是在单一阶段手术中，在可靠的临时皮肤覆盖下使自体皮重新上皮化。有必要进行一项前瞻性研究来衡量这项新技术的客观效果。
