Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt.
Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt.
Burns. 2022 Nov;48(7):1632-1644. doi: 10.1016/j.burns.2022.01.016. Epub 2022 Jan 29.
Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique.
A prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS - Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively.
The percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer's overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001).
The Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive.
在全球范围内，烧伤是 1-9 岁儿童因伤致死的第三大主要原因。然而，小儿烧伤的处理一直具有挑战性；由于供体部位有限，以及供体或受区部位的美观外观会对儿童以后的生活造成影响。可能需要进行皮片移植扩张，以尽量减少供体皮片的大小，或者在供体部位有限的患者中进行。已经描述了多种用于皮片扩张的技术，主要是网格和 Meek 技术。
2019 年 1 月至 2020 年 6 月，对 40 名患有深真皮和全层烧伤的小儿烧伤患者进行了前瞻性随机对照研究。患者分为 Meek 组和网格组。在术后 3 个月，评估两组的皮片成活率、上皮化时间、手术总时间和美学效果（使用 POSAS-患者和观察者瘢痕评估量表）。
Meek 组（84.25%）的皮片成活率明显优于网格组（71.5%）（P=0.006）。Meek 组的上皮化时间（27.11 天）优于网格组（33.5 天）（P=0.176）。此外，Meek 组的感染率（25%）低于网格组（40%）（P=0.311）。主观上，POSAS 瘢痕评估量表显示 Meek 组的结果更好，平均评分为 3.17，而网格组为 4.2（P=0.048）。观察者的整体评分也更好，Meek 组的平均整体意见评分为 2.89，网格组为 4.1（P=0.003）。Meek 技术的手术时间比传统的网格器长（P<0.001）。
Meek 技术用于扩张皮片覆盖烧伤创面，具有更高的扩张率、更易应用、更高的皮片成活率和更好的瘢痕外观，优于传统的网格器。然而，Meek 技术具有相当大的学习曲线，手术时间更长，而且更昂贵。
