The use of the Meek technique in conjunction with cultured epithelial autograft in the management of major paediatric burns

Abstract Background The management of major paediatric burns remains challenging, in part due to limited donor sites. Skin graft expansion facilitates rapid closure of the burn wound, reducing the risk of sepsis. We reviewed our unit's experience with a combined modified Meek technique and cult...

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Bibliographic Details
Published in:Burns 2013-06, Vol.39 (4), p.674-679
Main Authors: Menon, Seema, Li, Zhe, Harvey, John G, Holland, Andrew J.A
Format: Article
Language:English
Subjects:
Burns - surgery
Cell Culture Techniques - methods
Cells, Cultured
Child
Child, Preschool
Critical Care
Cultured epithelial autografts
Epithelial Cells - transplantation
Female
Humans
Keratinocytes
Male
Meek
Meshed grafts
Paediatric
Retrospective Studies
Skin Transplantation - methods
Tissue Expansion - methods
Transplantation, Autologous
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Summary:Abstract Background The management of major paediatric burns remains challenging, in part due to limited donor sites. Skin graft expansion facilitates rapid closure of the burn wound, reducing the risk of sepsis. We reviewed our unit's experience with a combined modified Meek technique and cultured epithelial autograft (CEA). Methods A retrospective chart review over a seven year period from April 2004 to April 2011 was conducted of patients whose burns were treated with Meek and CEA. Results The Meek technique was combined with meshed split skin grafts and CEA to either donor, graft site or both in 7 cases. One case had Meek skin grafts alone with cultured cells applied to both donor and graft sites. There were two scald burns and five flame burns, with total body surface area ranging from 30% to 70%. Mean length of stay was 51 days (range 41–74 days). The average number of surgical procedures undergone to obtain good coverage was 3.3. There were small (1–3%) areas of breakdown in six cases which received regrafting. Two of these patients had confirmed wound infections. All patients had varying degrees of hypertrophic scarring (HTS) but remained well at follow up. Conclusions The Meek technique facilitates high expansion ratios, allowing for a greater area of skin coverage. Epithelialisation in the burn wound appeared to be enhanced by the application of CEA. The Meek technique in combination with CEA would appear a useful additional option in achieving wound closure in the severely burned paediatric patient.
ISSN:0305-4179
1879-1409
DOI:10.1016/j.burns.2012.09.009