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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.
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.
Figure 1Procedure. (A) The first rows of incisions are made, with horizontal spacing 2d, vertical spacing g and length L. (B) Further rows of incisions are made between the initial rows. (C) The meshed pattern now enables the skin graft to be expanded.
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.
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.
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.
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