A machine-meshed split-skin graft is an effective method of grafting large difficult wounds and burns.
- Tanner Jr., J.C.
- Vandeput J.J.
- Bradley W.H.
Two years with mesh skin grafting.
Am J Surg. 1966; 111: 543-547
2.Sometimes the skin-meshing machine is unavailable. I offer a technique for producing a meshed skin graft with a predetermined expansion ratio. Established calculations are used to discuss how the measurements can be changed to produce various expansion ratios and how the measurements affect healing time. This hand meshing is easy and effective.
- Davison P.M.
- Batchelor A.G.
- Lewis-Smith P.A.
The properties and uses of non-expanded machine-meshed skin grafts.
Br J Plast Surg. 1986; 39: 462-468
The split-skin graft is placed on a wooden skin-graft board, stretched and its corners fixed with staples to an underlying sterile theatre sheet. Rows and columns of uniform cuts in a set pattern are made with a no. 15 surgical blade. The geometric mesh pattern has the following parameters: the cuts have a fixed length, L, and fixed vertical, g, and horizontal, d, separations. First, two rows of cuts are measured and made; the cuts have length L, are separated from each other by 2d and have a vertical separation of g (Fig. 1(A)) . Next, two new rows with the same parameters are placed between the first two rows so that the cuts are equidistant (Fig. 1(B)). The position of the first cut of the new row is determined by the horizontal separation, d, between each cut and the overlap, o, of adjacent cuts.
If there is no overlap, there is very little expansion. This pattern is repeated until it covers the entire area of the skin. Repeated measurements do not need to be made, as the length and spacing of the cuts can be judged by eye. The edges of the graft must be cut, even if only a fraction of the cut can be made, in order to allow expansion at the edge of the graft. When tension is applied to the skin graft to overcome the elasticity, the mesh pattern expands uniformly and the skin covers an increased surface area (Fig. 1C). This process is easy, effective and requires no special equipment. The surgical blade is replaced when it is blunt.
The modified equation published by Vandeput et al can be used to calculate the theoretical expansion ratio for this geometric mesh pattern.
- Vandeput J.
- Nelissen M.
- Tanner J.C.
- Boswick J.
A review of skin meshers.
Burns. 1995; 21: 364-370
If Rexp is the theoretical expansion ratio, L is the length of the cut, d is the distance between the cuts and g is the vertical gap between cuts, then:
When the measurements are L=20 mm, d=5 mm and g=10 mm, the expansion ratio, to two decimal places, is 1.67:1.
The formula for predicting the healing time of the meshed skin graft is based on the assumption that healing by epithelialisation of the mesh interstices occurs at a rate of 1 mm day.
- Vandeput J.J.
- Tanner J.C.
- Boswick J.
Implementation of parameters in the expansion ratio of mesh skin grafts.
Plast Reconstr Surg. 1997; 100: 653-656
If t1 is the healing time in days and L is the length of the cut in mm, then:
When L=20 mm, the healing time is 14 days.
Table 1 shows how the parameters can be changed to produce different expansion ratios and gives the estimated healing times.
Table 1Theoretical expansion ratios for various parameters (L: length of cut; d: distance between cuts; and g: vertical gap between cuts)
|L(mm)||d(mm)||g(mm)||Expansion ratio||Healing time(days)|
This method of meshing allows the use of relatively large cuts on a moderately sized piece of skin. The technique is limited by the lack of precision of handmade cuts. Previously described methods to be used when a skin-meshing machine is unavailable have not indicated the measurements needed for expansion.
- Yanai A.
- Hiraga Y.
Method for preparing meshed skin grafts without using skin-graft meshers.
Plast Reconstr Surg. 1991; 88: 524-526
6.The geometric mesh pattern I describe is simple, and predetermined measurements can give a predictable expansion ratio.
- Eroglu L.
- Uysal O.A.
An easy and effective method for preparing meshed skin grafts.
Plast Reconstr Surg. 2001; 108: 1083-1084
- Two years with mesh skin grafting.Am J Surg. 1966; 111: 543-547
- The properties and uses of non-expanded machine-meshed skin grafts.Br J Plast Surg. 1986; 39: 462-468
- A review of skin meshers.Burns. 1995; 21: 364-370
- Implementation of parameters in the expansion ratio of mesh skin grafts.Plast Reconstr Surg. 1997; 100: 653-656
- Method for preparing meshed skin grafts without using skin-graft meshers.Plast Reconstr Surg. 1991; 88: 524-526
- An easy and effective method for preparing meshed skin grafts.Plast Reconstr Surg. 2001; 108: 1083-1084
© 2003 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.