The use of sheet autografts to cover extensive burns in patients.

We previously have reported on the enhanced cosmetic and functional outcome with the use of sheet autografts. The recent goal has been to cover larger surface areas with sheet grafts, or for patients with larger burns, covering the hands and face with sheet grafts, if possible. To evaluate the use of sheet grafts in burns of more than 30% total body surface area (TBSA), the percentage covered with sheet and meshed autograft was reviewed in 105 patients admitted between January 1, 1990, and August 30, 1994. Results were that 18 patients (17%), with a mean of 44.3% TBSA burns, had all of their full-thickness wounds (mean, 36.5% +/- 2.2%; range, 20% to 55.5%) covered with sheet grafts (Group 1). Seventeen patients (16%), with mean burn size of 64.3%, had their wounds (mean, 35.1% +/- 4.4%; range, 15% to 79%) covered solely with mesh graft (Group 2). The lower percentage covered by mesh alone was skewed by the high mortality rate (53%) in this group. Seventy patients, 58.4% +/- 19% (range, 30% to 92%) TBSA burn, had their full-thickness wounds covered with a combination of mesh and sheet graft (Group 3). In Group 3, the mean percentage of TBSA covered by sheet grafts was 15.0% +/- 1.4% (range, 1% to 42.5%) and that covered by meshed grafts was 39.4% +/- 2.6% (range, 4% to 93%). Three quarters (73%) of patients in this group had sheet grafts placed on the face, whereas 63% had them placed on the hands. Extremities and the trunk were more often grafted with mesh graft. Sheet grafts were the sole coverage in patients with burns up to 55.5%. With even larger burns, sheet grafts were used to cover the face and hands. Because of its superior cosmetic and functional outcome, sheet autografting should be considered for covering moderately sized burns. Sheet autografting should be considered for more important cosmetic and functional areas, such as the face and hands, for massive burns.