Meek technique

The Meek technique is a useful technique for patients with extensive burn wounds who do not have sufficient donor sites available to close the burn wounds with general autologous skin grafts at once, even after meshing.

The Meek technique uses a split-thickness skin graft (SSG) cut into squares and using a Meek-dermatome to reduce those to smaller square-shaped islands. The square cut into smaller squares is placed on pre-folded gauzes, to achieve an expansion of 1:9.

You need specific tools to carry out this technique:

  • Tools list

Staged grafting: an alternative to the Meek technique

Staged grafting is an alternative if resources are limited and you cannot perform the Meek technique. It involves closing the burn during multiple surgeries to limit the peri-operative risks. After healing, you can harvest the graft from the same donor site again. A disadvantage is that this strategy takes a lot of time and may result in extensive scarring of the burn.

The Meek technique: step-by-step

Preparation

1 Choose a suitable donor site, preferably the thigh or scalp.

2 Shave the donor site. If you use the scalp, shave the donor site prior to surgery, when the patient is conscious

3 Clean the donor site and the burn wound with an antiseptic (iodine, Betadine or chlorhexidine) and apply sterile draping.

4 Decide which amplification of the skin graft to use (1:2/1:3/1:4/1:6/1:9). In practice, 1:9 is most commonly used to cover the largest possible area with minimal donor side morbidity.

5 Count the number of corks you need. One cork is 4.2 cm. However, the amount of cork required depends on the amplification of the skin graft. To measure this, either use an unfolded plisse of the correct amplification or cut out the size of an unfolded plisse from a mesh and use that as a measuring tool. For example, if you require 18 plisses of 1:3, then the donor site is 18x4.2.

6 Set the dermatome. Determine the size of the blade and adjust the thickness.

1 Prepare your instruments

Debridement

  1. Remove the eschar/granulating tissue from the wound with a normal surgical knife, weck blade, Humby knife or dermatome, to obtain a healthy wound bed.
  2. Cover the wound with an adrenaline-soaked gauze and dress it with a temporary bandage to reduce bleeding.
  3. Tip: Beware that in practice the thickness of the graft may vary with the same dermatome setting. Therefore, check the space between the dermatome blade and guard with a size 10 scalpel blade. Only the bevel of the blade should enter to get the right graft thickness.

Harvesting

1 Harvest the SSG using the dermatome. Do not use oily lubricants at any time.

2 Dampen the cork plates in saline solution.

3 Place the skin graft on a carrier or a soaked gauze, spread the skin graft out with the dermal (shiny) side up and cover it with saline-soaked gauze to prevent dehydration.

4 Cover the donor site with an adrenaline-soaked gauze or (wet) Kaltostat to reduce bleeding.

1. Harvest using the dermatome.
2. The cork plates
3. Skin graft on gauze, dermal side up

Expansion/Meek technique

  1. Apply cork plates on the dermal (shiny) side of the skin graft and cut the skin graft on the edge of the cork plate with a blade. Make sure the skin graft is not bigger than the cork plate but stays within the edges of the cork. Photo 1
  2. After you have placed all the skin grafts on cork plates, cut the corks with the Meek-dermatome or with a surgical blade 10 or 15 in both directions, leaving small squares of skin grafts.
  3. Spray all the cork plates with the cut skin grafts (epidermal side of the skin graft up on the cork plates) with an adhesive dressing spray. Photo 3
  4. Wait 5-7 minutes.
  5. Press the cork plates onto the pre-folded polyester gauze. The pre-folded polyester gauze comes folded on tin foil.
  6. Expand the pre-folded polyester gauze by pulling on the edges. First pull the ribbed edges and then the smooth edges.
  7. Remove the cork, leaving the square-shaped islands of autograft on the gauze.
  8. Remove the polyester gauze from the tin foil.
  9. Perform hemostasis of the burn wound and staple the polyester gauze to the wound with the graft side down.
1. Cork plates on dermal side of graft.
2a. Cutting small skin squares
2b. Cutting small skin squares
2c. Cutting small skin sqaures
3. Apply adhesive dressing
5. Graft fixed on the pre-folded polyester gauze
7a. Remove the cork plate
7b. Gauze with graft after removal cork plate
7c. Gauze with the small graft islands expanded
7d. Expand the gauze
8. Remove the gauze from the foil
9. Apply the grafts on the wound
Image of the Expansion/Meek Technique

Dressing

  1. Cover the polyester gauze with gauzes soaked in topical antiseptics (for example, furacin oil) and dress with dry bandages.
  2. Check the donor site for hemostasis and dress the wound with the preferred local dressing material (foam dressing, alginate dressing, semipermeable film dressing or Vaseline gauzes).

Post-operative care

  • The first day after the surgery, examine the patient for bleeding or hematoma formation.
  • The dressings should be soaked in local antiseptics. Change them daily.
  • Remove the staples fixing the polyester gauzes in place after a week.
  • Remove the polyester gauzes when epithelialization is complete, usually at least 7-10 days after surgery.
  • When you remove the polyester gauzes, inspect the wounds and treat with local antiseptics such as Fucidin®, Bactroban® or Betadine®.

Meek technique

Primary Item (H2)Sub Item 1 (H3)
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