Klosová H, Němečková Crkvenjaš Z, Štětinský J
Acta Chir Plast. 2017 Summer;59(1):11-17.
Early necrectomy and skin autotransplantation are prerequisites for successful treatment of extensive burns. Insufficient autograft donor site availability is a limiting factor. The Meek micrografting technique, published by C. P. Meek in 1958, appears to be a potential solution. Skin grafts are cut into micrografts and expanded at a ratio of 1:3, 1:4, 1:6 or 1:9. Thus, even in cases with limited donor site availability, it is possible to cover large areas after necrectomy.
Meek micrografting was first used at the University Hospital Ostrava Burns Centre in 2013. To date, 14 operations have been performed in 4 patients with extensive burn trauma. Engraftment, healing rate, and subsequent scarring (with a particular focus on scar contracture formation) were observed postoperatively.
The average micrograft success rate was 86.5%. The best success rates were observed in areas with deferred transplantation after necrectomy. Hypertrophic scarring occurred in both Meek and meshed transplant areas. No scar contractures requiring surgical management developed in micrografted areas. Surgical scar contracture release was required in 1 patient who underwent meshed graft transplantation.
The Meek technique demonstrated significant advantages. Micrografts can be prepared with very small skin grafts, which is impossible with the mesh technique. Meshed grafts with expansion ratios of 1:3 or higher require allograft or xenograft coverage. In our experience, overlays were not necessary for micrografts with a 1:6 expansion ratio. Given that no serious scar contractures developed in micrografted areas, we speculate that micrografts may pose a lower risk for their development when compared to meshed grafts. The disadvantage of the Meek technique is greater economic demands.
Meek micrografting is effective in the surgical management of deep burns in extensive thermal injuries with limited donor site availability...
早期坏死组织切除和自体皮肤移植是大面积烧伤成功治疗的前提条件。自体移植供区可用面积不足是一个限制因素。1958年C.P.米克发表的米克微型移植技术似乎是一个潜在的解决方案。皮肤移植物被切成微型移植物，并以1:3、1:4、1:6或1:9的比例进行扩展。因此，即使在供区可用面积有限的情况下，坏死组织切除后也有可能覆盖大面积创面。
2013年，米克微型移植技术首次在俄斯特拉发大学医院烧伤中心使用。迄今为止，已对4例大面积烧伤患者进行了14次手术。术后观察移植成功率、愈合率及随后的瘢痕形成情况（尤其关注瘢痕挛缩的形成）。
微型移植物的平均成功率为86.5%。在坏死组织切除后延迟移植的区域观察到最佳成功率。米克移植区和网状移植区均出现了增生性瘢痕。微型移植区未出现需要手术处理的瘢痕挛缩。1例接受网状移植的患者需要进行手术瘢痕挛缩松解。
米克技术显示出显著优势。微型移植物可以用非常小的皮肤移植物制备，而网状技术则无法做到。扩张比例为1:3或更高的网状移植物需要同种异体或异种移植物覆盖。根据我们的经验，对于扩张比例为1:6的微型移植物，无需覆盖物。鉴于微型移植区未出现严重的瘢痕挛缩，我们推测与网状移植物相比，微型移植物形成瘢痕挛缩的风险可能更低。米克技术的缺点是经济成本更高。
米克微型移植技术在供区可用面积有限的大面积热损伤深度烧伤的手术治疗中是有效的……
