Meshed Skin Research Articles

Expansion limits of meshed split-thickness skin grafts

Split-thickness skin grafts are widely used to treat chronic wounds. Procedure design requires surgeons to predict how much a patch of the patient's own skin expands when it is meshed with rows of slits and stretched over a larger wound area. Accurate prediction of graft expansion remains a challenge, with current models overestimating the actual expansion, leading to suboptimal outcomes. Inspired by the principles of mechanical metamaterials, we developed a model that distinguishes between the kinematic rearrangement of structural elements and their stretching, providing a more accurate prediction of skin graft expansion. Our model was validated against extensive data from skin graft surgeries, demonstrating vastly superior predictive capability compared to existing methods. This metamaterial-inspired approach enables informed decision-making for potentially improving healing outcomes. Statement of SignificanceAccurately predicting the expansion of meshed skin grafts is crucial for minimizing patient trauma and optimizing healing outcomes in reconstructive surgery. However, current quantitative models, which treat grafts as tessellated trusses of rigid bars, fail to accurately estimate graft expansion. We have uncovered the mechanisms underlying skin graft expansion and developed a straightforward method based on these findings. This method, designed for practical use by surgeons, provides accurate predictions of graft expansion, as validated against extensive data from skin graft surgeries.

Topical application of beta-blockers accelerates epithelialization to mesh skin grafted full-thickness burn in sheep

Aim : Beta-adrenergic receptor blockers are conventionally used for the treatment of hypertension, tachycardia, and glaucoma. Research has shown that beta-blockers can accelerate wound epithelialization. In this study, we tested the efficacy of the beta-blocker timolol in an ovine model of grafted full-thickness burn wound healing, which closely mimics clinical scenarios. Methods : Six full-thickness burn wounds were created on the sheep’s posterior surface. Twenty-four hours later, eschars were excised and meshed skin was grafted (Day0). The wounds in the treatment group received topical application of timolol. Blood flow was measured using a blood perfusion imager. Cardiovascular hemodynamics and blood glucose levels were recorded daily. The epithelialization rate on Day 14 was determined by planimetric assay and analyzed by paired t -test. The days that the epithelialization rate exceeded 85%, 90%, and 95% were analyzed by survival analysis. To assess the potential influence of TGFβ, epithelial-mesenchymal transition (EMT), or myofibroblast activation (MFA) on wound healing, the RNA abundance of gene products related to these pathways was measured by reverse transcription and quantitative polymerase chain reaction (RT-qPCR). Results : The epithelialization rate on Day 14 was significantly higher in the treatment group. The days that the epithelialization rate exceeded 85%, 90%, and 95% were significantly shorter in the treatment group. There was no significant difference in wound blood flow or RNA abundance related to TGFβ, EMT, or MFA-related pathways among the groups at any time point. Conclusion : The results demonstrate that the beta-blocker timolol accelerates epithelialization of mesh skin grafted full-thickness burn wounds through a mechanism other than improving wound blood flow.

Severe Antiphospholipid Syndrome in a Child with Chicken Pox: Clinical Case

Background. Antiphospholipid syndrome develops at autoimmune diseases, pregnancy, or genetic predisposition, and it is characterized by high risk of thrombosis in arterial, venous, and capillary vessels. This syndrome in children is rare, and necrotic skin lesions occur in the most extreme cases. Clinical case description. A child, 1 year old, with chicken pox has developed hemorrhagic rash on his back, swelling of the left shoulder and forearm on the 4th day of the disease. Medical treatment included acyclovir, ceftriaxone, sodium heparin. Aggravation of hemorrhagic rash over the body, spread of edema from the left shoulder to upper arm and neck, formation of flaccid bubble and necrosis locus (75 cm) on the outer upper third of the left shoulder were noted on the 5th-6th day. Increase in the levels of antibodies to 2-glycoprotein I (IgG — 48.9 U/ml, IgM — > 100 U/ml) and cardiolipin (IgM — 73.0 U/ml) was revealed. The diagnosis “antiphospholipid syndrome” was established. All necrotized tissues were removed on the 11th day, and the wound defect (86 cm) was subsequently covered by mesh skin grafts. The levels of antibodies (IgG + IgM) to 2-glycoprotein I remained high, 45.2 U/mL, 12 weeks after the onset of the disease. Thus, it has confirmed the development of antiphospholipid syndrome. The child continued treatment with warfarin (3.75 mg/day) with INR control. Conclusion. Hemorrhagic skin lesions in children with infectious diseases requires laboratory diagnostics of antiphospholipid syndrome, early prescription of anticoagulant and antiplatelet therapy, and surgical support.

Fournier's Gangrene reconstruction in black patients using SCIP flap and split thickness skin graft: 2 case reports and a literature review

Fournier's gangrene is a potentially life-threatening infectious disease involving the perineum and genitals. Aggressive surgical and medical management is often required, leaving the patient with large integumentary defects. The multiplicity of reconstructive options reported highlights the lack of consensus on the best covering option. Functional and aesthetic considerations are in play, and the literature is scarce on male black patients. We report here two cases of dark-skinned patients presenting with scrotal and penile integumentary defects that were respectively reconstructed with a superficial circumflex iliac artery propeller perforator flap and a split-thickness meshed skin graft and discuss the available literature on the topic.

Repairing Exposed Tendon Wounds with Absorbable Gelatin Sponges and Autologous Split-Thickness Skin Grafts: A Case Series.

Conventional flap repair surgery has several drawbacks, including operational complexity, donor site damage, and high risk. In this case series, the authors explored an alternative approach for repairing exposed tendon wounds caused by trauma using absorbable gelatin sponges (AGSs) and autologous thigh skin grafts. This report presents two cases of lower-extremity skin necrosis with tendon exposure following wound debridement. The treatment approach involved early debridement, negative-pressure wound therapy, and wound irrigation with 0.9% sodium chloride. Upon achieving controlled wound infection, AGSs were applied to the exposed tendon to prevent degeneration and promote wound healing. Subsequently, areas where granulation tissue failed to cover the tendon were repaired using AGSs and 0.25-mm-thick autologous mesh skin grafts harvested from the thigh. Complete wound healing was achieved in both cases, on the 20th and 12th day after skin grafting, respectively. The proposed method proved successful in repairing exposed tendon wounds, effectively preventing infection and necrosis.

Giant pretibial cellular fibrous histiocytoma colliding with an epidermal cyst

Histiocytomas are common benign tumors of the skin. In contrast, giant histiocytomas are a rarity. We report a 43-year-old male patient, who presented with a 7 × 6 cm large firm tumor on his left lower leg. This was a long-standing lesion, but within the last three months, the tumor developed an exophytic nodule. A skin biopsy revealed an atypical spindle-cell tumor. We decided to perform a complete excision with a safety margin. Complete histopathological analysis confirmed the diagnosis of a collision tumor composed of a cellular fibrous histiocytoma and an epidermal cyst. The resulting defect was temporarily closed by vacuum-assisted closure before eventually a meshed split skin graft was transplanted. Proliferating fibrohistiocytic lesions should be surgically removed, and a careful histopathologic analysis is necessary to avoid delayed diagnosis of possible malignant lesions.

Combining Surgical Innovations in Amputation Surgery-Robotic Harvest of the Rectus Abdominis Muscle, Transplantation and Targeted Muscle Reinnervation Improves Myocontrol Capability and Pain in a Transradial Amputee.

Adding robotic surgery to bionic reconstruction might open a new dimension. The objective was to evaluate if a robotically harvested rectus abdominis (RA) transplant is a feasible procedure to improve soft-tissue coverage at the residual limb (RL) and serve as a recipient for up to three nerves due to its unique architecture and to allow the generation of additional signals for advanced myoelectric prosthesis control. A transradial amputee with insufficient soft-tissue coverage and painful neuromas underwent the interventions and was observed for 18 months. RA muscle was harvested using robotic-assisted surgery and transplanted to the RL, followed by end-to-end neurroraphy to the recipient nerves of the three muscle segments to reanimate radial, median, and ulnar nerve function. The transplanted muscle healed with partial necrosis of the skin mesh graft. Twelve months later, reliable, and spatially well-defined Hoffmann-Tinel signs were detectable at three segments of the RA muscle flap. No donor-site morbidities were present, and EMG activity could be detected in all three muscle segments. The linear discriminant analysis (LDA) classifier could reliably distinguish three classes within 1% error tolerance using only the three electrodes on the muscle transplant and up to five classes outside the muscle transplant. The combination of these surgical procedure advances with emerging (myo-)control technologies can easily be extended to different amputation levels to reduce RL complications and augment control sites with a limited surface area, thus facilitating the usability of advanced myoelectric prostheses.

CEA graft take after combining with a modified MEEK procedure

Resourceful surgical planning for coverage of large burns has led to refinement of early innovative procedures including meshed split thickness skin grafts (STSG), MEEK procedure, and use of cultured epidermal autografts (CEAs). The use of STSG remains standard of care for burn wound coverage; however, manual expansion of STSG is limited due to shortcomings with expansion rates greater than 4:1. The MEEK micrografting method is a method of preparing skin grafts with a device instead of manually with an autograft mesher, allowing reliable expansion rates of autografts up to 9:1. Although the CEA indication for use includes both with and without STSG, use of meshed STSG placed under CEA has been reported to minimize shear forces and hasten graft take. The purpose of this study was to evaluate success of graft take in patients receiving MEEK and CEA for wound coverage in extensive burns at a single burn center experienced in the use of both MEEK and CEA. Data in 15 patients who received both MEEK and CEA for the treatment of large burns (mean total body surface area [TBSA] of 66%) demonstrated a high rate of successful engraftment (87%), and an overall 73% survival rate.

Acute management of skin tears with mesh grafting: a prospective study and cost-benefit analysis

**Background**: Skin tears cause a significant burden to the patient and healthcare system. Acute management has traditionally comprised of operative debridement and formal skin grafting, which is costly, invasive and often followed by admission for five to seven days. In a 2014 pilot study by Vandervord and colleagues, a protocol for re-laying the skin tear as a meshed skin graft (mesh protocol) was proposed, which has not been validated to date. Our study aims to compare a prospective cohort to the original pilot study to determine validity in clinical practice and provide an updated cost-benefit analysis.**Method**: All patients who presented with acutely sustained skin tears at Northern Beaches Hospital, NSW, Australia, were prospectively entered into the mesh protocol as described by Vandervord and colleagues. An updated cost-benefit analysis was performed using a national hospital cost data collection report produced by the Independent Hospital Pricing Authority (IHPA).**Results**: We enrolled 53 patients onto the protocol who had sustained a total of 64 discrete skin tears, with 11 patients sustaining more than one skin tear. The average age of patients was 86, and the most common location of the skin tear was pretibial, followed by forearm/hand. Only one patient required a return to theatre for debridement and formal skin grafting, and three patients required long-term dressings for partial mesh graft loss. The cost to the healthcare system is consistent with the pilot study, with a significant difference between discharge from the emergency department post-procedure and formal grafting and admission for five to seven days.**Conclusion**: Use of the mesh protocol creates wound coverage and prevents the need for formal skin grafting, and reduces costs associated with formal operations and hospital admissions.

Minced skin grafts for chronic wounds compared to conventional mesh grafts.

Skin grafting is the single most effective method to close a chronic wound. The current standard of care is to use meshed split thickness skin grafts. This entails the use of surgical instruments that need to be autoclaved and to have a power source, which usually requires an OR facility. The minced skin technique uses single use, presterilized instruments and the procedure can be done under local anesthesia, by a wound care practitioner, in a wound clinic, a physician's office or even at the bedside. The current study was designed to determine if the results from micrografting were non inferior to conventional mesh grafting. In a prospective non inferiority study, 26 chronic ulcers were treated with micrografting (MSG) and 24 with conventional mesh grafts 1:3 (control group-CG) in a total of 21 patients, 10 male and 11 female. The donor site areas in the MSG group were predetermined to 2.5 × 5 cm and the mesh grafts expansion was set at 1:3. In the first weeks postoperatively, micrograft healing initially lagged behind the conventional mesh grafts but at 60 days after grafting, all MSG wounds were healed. The MSG wounds had better pigmentation, less itching,and less scarring. The micrografting procedure was easy to learn and expeditious to perform. The MSG mean expansion was 9.1 compared to three times (CG). The MSG procedure is not inferior to conventional mesh grafting, requires smaller donor sites, and can be done with single use instruments, under local anesthesia, with early discharge.

A dynamic virtual try-on simulation framework for speed skating suits

Speed skating suits have important effects on performance of athletes, and they also protect human body to avoid injury in competitions. Appropriate patterns including structure and shape influence the wearing comfort, which is a main factor of athletes’ action performance. Sport wears provide different pressure on human body because of their surface tension, and suitable pressure is helpful to athletes to perform actions freely. However, design and adjustment of tight-fitting suits to achieve satisfying press distribution are hard works, because the pressure distribution cannot be measured directly in dynamic process of sport actions. This paper proposes a dynamic virtual try-on simulation framework for speed skating suit. First, a skeleton supported virtual human model with fixed structure skin mesh is created, and the model can be deformed according to speed skating actions. Second, a typical sport suit including 5 parts is created on the human body skin model as a virtual try-on framework, thus all the suit’s parts are deformed driven by human model. Finally, deformations of suit parts are calculated frame-by-frame in dynamic process, and the deformation rate is considered as the tense distribution of fabric which can be transformed to pressure by curvature radius. The deformation rate distribution of different area on three-dimensional suit part provides a direct visual reference to the pattern adjustment. The results show that our framework is feasible to speed skating suit pattern making works.

Giant basal cell carcinoma of the scalp: rotation advancement flap as a successful dermatosurgical approach.

Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, and maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice, from surgical removal, waiting for granulations to form, and placing a split skin mesh graft (at a later stage) to performing complex rotational/transpositional or advancement flaps. Achieving an optimal aesthetic result is often the consequence of interventions carried out or based on the decisions of multidisciplinary teams. Alternatives, such as radiotherapy and targeted therapy with vismodegib, could be administered both preoperatively and postoperatively or as first-line therapy, depending on the tumor board decisions. We present the case of a 69-year-old female patient with a histopathologically proven preoperative giant basal cell carcinoma of the scalp that did not infiltrate the tabula externa. A preoperative ultrasound was performed to preserve the feeding flap arteries. Surgical treatment under general anesthesia was planned and subsequently carried out. During surgery, the surgical resection lines were in close proximity to the arterial vessels, but they remained preserved and ensured a subsequently unproblematic healing process. After the application of the rotational advancement flap technique under general anesthesia, an optimal cosmetic effect was achieved.

Patients with adult-acquired buried penis and their surgical management: a single-center study

Adult-acquired buried penis (AABP) is a condition in which the suprapubic fat (the escutcheon) conceals the penis. The etiologies of AABP include obesity, pelvic lymphedema, lichen sclerosis, and scar contraction following a circumcision. If untreated, AABP can lead to hygiene-related infections, urinary and sexual disorders, and psychological issues, such as depression, diminished self-esteem, and poor quality of life. When weight reduction fails to resolve this condition, surgical correction can successfully manage the patient’s AABP. The goal of surgical repair is to extract the telescoped penis from the escutcheon. In our experience, this has been successful with a urologist/plastic surgeon team. Cases of surgical repair for AABP performed at a single medical center from 2012 to 2022 were retrospectively reviewed. Fourteen patients, whose age ranged from 40 to 74 years old, were identified, and their characteristics as well as the surgical techniques performed on them were reviewed. All patients were obese, their body mass index ranging from 32.1 to 62.4; eight patients were severely obese. Five patients had a history of adult circumcision, 5 had a prior diagnosis of lichen sclerosis, and 3 had genital lymphedema. The initial procedures were routine but with some variation. The surgical techniques included performing a panniculectomy and/or an escutcheonectomy, degloving the penis, removing nonfunctional fibrotic tissue, incising the suspensory ligament, and using a meshed split-thickness skin graft (STSG) for penile coverage. The most common complication was wound dehiscence. Two patients with complications required a return to the operating room; one patient returned for closure of an infected wound and the other for penile reconstruction and the placement of a new STSG for lymphedema. All patients eventually recovered, with no further complications reported.

Skin Grafting on Wound with Exposed Bone

Introduction: In general, exposed bone wounds are covered with flaps. If the wound is small, skin grafting with perifascial areolar tissue can be performed for resurfacing; however, it is not suitable for large bone-exposed wounds exceeding 5 cm in length.Methods: Six patients underwent skin grafting for bone-exposed wounds at our medical center between 2014 and 2020. In all cases, a suitable local flap donor site could not be found around the wound, and a suitable donor vessel to anastomose the free flap was difficult to find. After a sequestrectomy, slit artificial dermis was applied to the wounds, and basic fibroblast growth factor was sprayed. Ointment-impregnated gauze was applied to the wounds. After confirming the creation of a suitable wound bed, skin grafting was performed.Results: In all cases, after skin grafting, the exposed bone wounds were closed. Four cases were due to extensive burns, one was due to malignant tumor resection, and one was due to exposed bone after injury. For burn injuries, suitable skin flap donors were difficult to find. Three cases of bone exposure involved the skull, and the rest involved the anterior surface of the tibia. Four cases required split-thickness skin grafts (including two mesh skin grafts), and two required full-thickness skin grafts. Covering a wound after skin grafting took 3 weeks to 3 months (median, 1 month), which is much longer than the time taken when using a skin flap. Conclusion: Even for exposed bone wounds with poor blood circulation, a good wound bed can be created by the combination of artificial dermis and bFGF, and wound closure can be achieved by skin grafting. Bone-exposed wounds should be closed early using a skin flap. However, when the patient’s general condition is poor or when temporary closure is difficult due to the unavailability of a suitable donor, wound closure by skin grafting is a simple and useful treatment option, although it takes a long time.

Multicenter research of the dependence of skin graft engraftment and the concentration of blood hemoglobin, total serum protein and albumin

The Objective was to evaluate the effects of the concentration of blood hemoglobin, total serum protein and albumin on skin graft engraftment frequency.Methods and Materials. The study included 186 patients with full-thickness skin burn more than 5 % of total body surface area who were treated in five different burn departments of the Russian Federation. Depending on the readiness of the wounds, all performed surgical treatments were divided into four groups: 1) simultaneous skin graft after tangential necretomy; 2) simultaneous skin graft after radical necretomy; 3) skin graft for granulation wounds; 4) skin graft for a long time existing pathologically (hyper)granulation. Venous blood was taken from all the patients 12 hours before and 12–24 hours after skin graft. The concentration of blood hemoglobin, total serum protein and albumin was determined in the obtained samples. The evaluation of skin graft engraftment frequency was carried out by a combined method on the 7th day after skin graft. The data obtained were processed using descriptive and nonparametric statistics.Results. The concentration of total serum protein (p=0.001) and albumin (p=0.000) had a significant impact on the skin grafting results. This relationship was most pronounced during skin grafting on granulating wounds and after radical necretomy. The data obtained were identical for meshed and non-meshed skin grafts. Decrease in hemoglobin concentration did not lead to a degradation of skin grafts (p=0.068) in any of the study groups. According to the results of the laboratory parameters ranking, it was found that maintaining the concentration of total serum protein more than 6 g/dL allows 1.3 times to improve the results of skin grafting, and albumin concentrations more than 3.5 g/dL – 1.4.Conclusion. During the study, we were unable to confirm the existence of a relationship between the concentration of blood hemoglobin and the results of skin graft engraftment by any of the statistical analysis methods in any of the study groups. Accordingly, the inability to transfuse erythrocytes to a patient with anemia below 9–8 g/dL cannot be considered as an absolute contraindication for early surgical treatment of burned patients. Apparently, the concentration of total serum protein and albumin has a much greater effect on the skin grafting results. Trigger values of total serum protein can be recognized as 6 g/dL (albumin – 3.5 g/dL), which provides good results of engraftment in at least 90 % of operated patients.

Management of electric burn injury by NPWT, meshed skin graft and distant posterior thigh flap

Electric burn injuries can cause high morbidity and mortality. A 4.5-year-old child was admitted to our facility with deep full-thickness burns on the trunk and both lower limbs. After the patient's general condition was stabilized, numerous procedures were performed. A staged reconstruction resulted in stable coverage of the raw areas by meshed split thickness skin graft and distant posterior thigh flap. Nevertheless, the right limb below knee amputation had occurred. NPWT has a significant role in preparing the burned region for skin grafting, and the distant thigh flap remains a viable option in reconstructing the distal lower third of the leg.

Mesh Graft Urethroplasty-Still a Safe and Promising Technique in Mostly Unpromising Complex Urethral Strictures.

Long urethral strictures or even recurrent urethral strictures, mostly with scar tissue showing insufficient healing tendencies, are defined as complex and represent a big challenge in modern reconstructive urology. Initially, the treatment of complicated urethral strictures was associated with a high failure rate (20–40%) due to the growth of hair in the neourethra and a lack of sufficient suitable epithelium when scrotal skin was used. Although much effort was put into tissue engineering recently, harvesting and transplanting autologous tissue represent the standard of care for urethral substitution or augmentation. Since 1977, two-staged urethroplasty with the usage of free foreskin or 0.1 mm thick meshed skin from the upper leg was performed in complicated cases and was initially described in 1984 and 1989 by Schreiter and Schreiter and Noll, respectively. In stage 1, the graft is harvested by cutting the skin thinly above the hair follicles and transplanted as a plate around the opened urethra. In stage 2, after 8–12 weeks, the neourethra is formed. Success rates of up to 84% are described. Considering the complexity of the strictures in which mesh graft urethroplasty is usually performed, the reachable success rates are outstanding, especially considering that this surgery is most likely the last opportunity to prevent perineostomy or even urinary diversion. This article describes the surgical technique and embeds the mesh graft urethroplasty in today’s literature to underline its importance in the surgical management of complex urethral strictures.

Utilização de flap de omento para indução da cicatrização de enxertos cutâneos

ABSTRACT The objective of this study was to assess healing induction of free skin grafts following transposition of omental flap through a subcutaneous tunnel to the recipient bed. Macroscopic and microscopic evaluations were performed. Nineteen piglets were used. Two surgical wounds were created of each subject. The graft removed from the left side (LS) was placed on the right side (RS) without the omental flap in the graft-bed (control group-CG). On the LS, an omental flap was placed between the graft removed from the RS and the recipient bed (omentum group-OG). Macroscopic evaluations showed edema, which gradually decreased on both groups. Suture dehiscence was highest at day 10 compared to other days in both groups. The CG had a higher incidence of unvitalized tissue compared to OG, although no difference was found among days of postoperative evaluation. The presence of unvitalized tissue was seen on 32% on OG and 53% on CG. Microscopic evaluations revealed higher collagenization, reepithelization, keratinization and less swelling in the OG compared to CG. In conclusion, mesh skin grafts evolved satisfactorily in swine even in newly created bedding without granulation tissue, but with appropriate vascularization. The omentum flap provided better macroscopic and microscopic outcomes regarding graft integration.

Evaluation of the surgical and functional outcomes of secondary vaginoplasties with free skin mesh graft in patients following transfeminine genital reconstructive surgery.

BackgroundGender-affirming surgery is classically done using the penile inversion vaginoplasty technique, however in some patients it may not promote adequate depth. In patients whose vaginal conduits became short or stenotic, we propose to perform a secondary vaginoplasty using an abdominal free skin mesh graft. In this study, we present ours results of a series of cases using this technique.MethodsA retrospective review of patients undergoing secondary vaginoplasty with free skin mesh graft from 2000 to 2017 at our hospital was performed. Demographic data, surgical characteristics, complications, personal satisfaction and neovagina functionality (defined as the ability to have satisfactory sexual intercourse) were evaluated.ResultsOf 186 patients who were submitted to primary vaginoplasty, 36 patients (19.3%) were then submitted to secondary vaginoplasty. This study sample included 35 patients. The average age of patients was 41.0 years (37.0 to 50.5) and the average time between gender affirmation surgery and secondary vaginoplasty was 6 months (4–24). Ten patients (28.6%) developed postoperative complication, the most frequent being: neovagina introitus stenosis (22.9%), rectal fistula (8.6%), tissue dehiscence (2.9%), and urethral fistula (2.9%). Subjective personal satisfaction and neovagina functionality of patients was reported by 77.1% of the sample.ConclusionsOur study demonstrates that secondary vaginoplasty surgery using a free skin mesh graft has good results and is a functional option with low complexity and low rate of serious complications.

Hypergranulation over a meshed split-thickness skin graft, a complication of negative-pressure wound therapy: a case report

BackgroundWe present a case of a rare complication of negative-pressure wound therapy (NPWT) wherein there was fixation of a meshed split-thickness skin graft (STSG), suspected as a failure by hypergranulation. However, the meshed STSG was integrated within 5 days of NPWT cessation.Case presentationA 22-year-old Asian man sustained 25% total-body-surface-area flame burns. After multiple operations, an ulcer was present on the proximal left thigh. On day 37 after admission, the ulcer was debrided, and an 11/1000-inch (0.28 mm) skin graft was taken from the ipsilateral thigh and meshed, using a 1:1.5 ratio. NPWT was applied to the donor and recipient sites with a continuous negative pressure of 125 mmHg. On day 43, NPWT was discontinued. The skin grafts were not identified on the surface of the granulation tissue. With topical ointment therapy, rapid epithelialization of the ulcer was observed as the granulation tissue regressed. On day 48, the recipient site had completely epithelialized.ConclusionsThe hypergranulation tissue rarely covered the meshed STSGs when the grafts were fixed by NPWT. In that case, immediate debridement should be avoided, and conservative treatment should be initiated.