Micrografting Technique Research Articles

Selective enzymatic debridement and modified Meek technique in the treatment of extensive burns: Preliminary observations.

Selective bromelain-based enzymatic debridement (BED) has emerged as a valid alternative for the treatment of extensive burns, with Total Body Surface Area (TBSA) > 20%. Autologous skin grafting represents the procedure of choice but the scarcity of donor sites remains the main reconstructive challenge. The modified Meek micro-grafting technique may represent a valid strategy to optimize the final outcome. A single-cohort retrospective analysis was performed, involving nine burn patients (TBSA > 20%) who underwent both BED and subsequently modified Meek technique. Demographic and clinical data (mechanism of injury, surgical treatment, complications, necessity of re-grafting, further surgery and esthetic outcome) were collected. All patients had large burns of mixed and deep dermal thickness (first, second, and third degree). All burns were enzymatically debrided postadmission and covered by the modified Meek technique. Local infection due to poor general conditions was the main complication for all patients. All but two patients survived. The selectiveness of the enzymatic debridement and dermal preservation seemed to improve the quality of scars resulting from micro-grafting. Evaluations performed at 12 ± 2 months postburn showed superior scar quality compared to areas treated with traditional (sheet/mesh) grafts. Combined BED and Meek techniques may provide an effective synergic combination for the treatment of extensive burns.

Application of Meek micro-grafting technique in severe burn injury: a case report

Wound closure is often a challenge in patients with major burns due to the limited amount of healthy skin available for harvesting and grafting. As a result, this often yields severe morbidity and mortality amongst said patients. This case report presents the successful use of the Meek micro-grafting technique on a patient with extensive major deep dermal to full-thickness burn injuries in the Burn Unit of the Kuala Lumpur Hospital of Malaysia. The Meek micro-grafting method, involves the creation of micro-grafts from a small and limited donor site, and proved to be effective in promoting wound healing and minimizing donor site morbidity.

Use of the modified meek technique for the coverage of extensive burn wounds

IntroductionAutologous split thickness skin grafting using meshing technique remains the preferred option for the management of deep dermal and full thickness burns. The limited donor site availability seen in patients with extensive burns, however, restricts use of the mesh grafting technique for skin expansion. Meek micrografting was developed to allow for greater expansion, and, therefore, more reliable treatment of extensive burns. This study aimed to present our outcomes using the Meek micrografting technique and identify risk factors for graft failure. MethodsA retrospective review of patients admitted to our large academic hospital who were treated with the Meek micrografting technique from 2013 to 2022 was conducted. Patient demographics, surgical characteristics and outcomes were reported. Regression analyses were performed to identify factors that influence graft take and reoperation rate. ResultsA total of 73 patients with a mean age of 45.7 ± 19.9 years and mean burn size of 60.0 ± 17.8%TBSA, with 45.3 ± 14.9% TBSA being third degree burns, received Meek transplantation. The mean graft take after removal of the pre-folded polyamide gauze at the tenth post-operative day was 75.8 ± 14.7%. Pre-treatment with use of an allograft, longer waiting time between admission and Meek grafting and transplantation over a dermal matrix were identified as positive predictors for graft take, while age was established as a negative predictor. ConclusionBy examining the outcomes of the Meek micrografting technique in extensive burn wounds we identified that preconditioning of the wound bed, through allograft or negative pressure wound therapy application, positively correlates with improved outcomes, including higher graft take. At the same time, older age was seen to negatively correlate with graft take. Overall, Meek transplantation displays a favorable safety profile with promising outcomes. Future prospective studies and clinical trials can optimize the procedure and help establish it as the golden standard for extensive and complex burns.

Meek Micrografting Technique for Reconstruction of Extensive Necrotizing Fasciitis of the Anterior Abdomen and Bilateral Femoral Region: A Case Report.

Necrotizing fasciitis is an uncommon yet fatal soft tissue infection. Current recommended treatment includes antibiotics with repeat surgical exploration and wound debridement followed by reconstruction. In burn patients, the Meek micrograft has demonstrated a higher true expansion ratio, faster reepithelialization rate, more resilient toward infection, and reduced risk of graft failure as compared with meshed graft. To our best knowledge, the use of Meek micrografting technique in reconstruction of postdebridement wounds of necrotizing fasciitis has not been reported. Hereby, we present a case of a 57-year-old gentleman who was referred to us for wound reconstruction after surgical debridement of Fournier's gangrene and extensive necrotizing fasciitis involving the anterior abdomen and bilateral femoral region. Meek micrografting technique was used to reconstruct the anterior abdomen as the wound bed was large. Although the graft was complicated with a small area of localized infection, it did not spread across the entire graft and was successfully treated with topical antibiotics and regular wound dressing. In our case, wound reconstruction using Meek micrografting technique in a patient with extensive necrotizing fasciitis was successful and showed positive outcome. Therefore, we suggest further studies to be conducted to investigate the applications and outcomes of the Meek micrografting technique, especially in patients with extensive wound bed and limited donor site availability.

Use of left atrial appendage as an autologous tissue source for epicardial micrograft transplantation during LVAD implantation.

We report here the first clinical use of the left atrial appendage (LAA) for epicardial micrograft transplantation during left ventricular assist device (LVAD) implantation. Previously, a sample from the right atrial appendage (RAA) has been available for processing and administering micrograft therapy in cardiac surgery. Both LAA and RAA are rich sources of various types of myocardial cells and are capable of providing both paracrine and cellular support to the failing myocardium. The surgical approach of LAA micrografting facilitates epicardial micrograft therapy dose escalation and treatment of larger myocardial areas than done previously. Moreover, as collection of treated vs. untreated tissues from the recipient heart is possible following LVAD implantation at the time of heart transplantation, the evaluation of the therapy's mechanism of action can be further deciphered at cellular and molecular levels. This LAA modification of the epicardial micrografting technique has the overall potential to facilitate the adoption of cardiac cell therapy during heart surgery.

Three-Year Experience With Combined Complex Skin Repair in Patients With Extensive Burns: A Retrospective Study

Introduction. The Meek micrografting technique used in STSG expansion is effective in achieving wide and rapid coverage of burn wounds. Certain growth factors have also been shown to modulate or mediate wound healing. Objective. In this study, a combined treatment approach for severe burns involving the Meek micrografting technique, systemic application of rhGH, and topical application of rhEGF was evaluated. Materials and Methods. A retrospective study was conducted of 7 extensively burned patients who were treated with the Meek technique, systemic application of rhGH, and topical application of rhEGF between January 2017 and December 2019. Results. The mean percent TBSA burned was 89%. An average of 9.5 surgical procedures were performed to obtain skin cover, with an average of 5.8 Meek micrograft procedures performed in the 6 surviving patients. Complete wound healing was achieved at an average of 120 days in the 6 surviving patients. The mean graft take rate was 81%. Infection was the main reason for graft failure. Donor sites were used for up to 5 re-harvestings without additional morbidity. Conclusions. A multipronged treatment approach that combines the Meek micrografting technique, systemic application of rhGH, and topical application of rhEGF is a promising tool for the management of severe and extensive burns.

Rehabilitation of Geriatric Burn Patient Post-Meek Micrograft with Bilateral Partial Calcanectomy: A Case Report

Looking along the physiological and physical changes in aging, in the light of a major burn, co-morbidities, surgical intervention and precaution, a geriatric burn patient requires a delicate balance of ideal burn care and rehabilitation to achieve functional independence. A 70-year-old patient, with 30% total body surface area flame burn injury, underwent bilateral partial calcanectomy secondary to calcaneus osteomyelitis, and Meek micrograft technique for burn injury on bilateral lower extremities, is presented in this case report. In order to ensure good graft take, her knees were immobilized causing bilateral soft tissue contractures. Subsequently, upon initiation of ambulation, gait abnormalities observed include absence of heel off and toe off, with heel walking. The patient was admitted for intensive inpatient rehabilitation, where significant improvement in the knee range of motion and ambulation were achieved. The patient was eventually discharged ambulatory with walker. Despite expected complications, rehabilitation management proved to be beneficial in improving function and ambulation in geriatric burn patient.

Expansion of fibroblast cell sheets using a modified MEEK micrografting technique for wound healing applications

Cell sheet engineering, a scaffold-free approach to fabricate functional tissue constructs from several cell monolayers, has shown promise in tissue regeneration and wound healing. Unfortunately, these cell sheets are often too small to provide sufficient wound area coverage. In this study, we describe a process to enlarge cell sheets using MEEK micrografting, a technique extensively used to expand skin autografts for large burn treatments. Human dermal fibroblast cell sheets were placed on MEEK’s prefolded gauze without any use of adhesive, cut along the premarked lines and stretched out at various expansion ratios (1:3, 1:6 and 1:9), resulting in regular distribution of many square islands of fibroblasts at a much larger surface area. The cellular processes essential for wound healing, including reattachment, proliferation, and migration, of the fibroblasts on expanded MEEK gauze were superior to those on nylon dressing which served as a control. The optimal expansion ratio with the highest migration rate was 1:6, possibly due to the activation of chemical signals caused by mechanical stretching and an effective intercellular communication distance. Therefore, the combination of cell sheet engineering with the MEEK micrografting technique could provide high quality cells with a large coverage area, which would be particularly beneficial in wound care applications.

Differences in morphological, biochemical, and genetic characteristics of grape explants grafted using various micrografting techniques

This study aimed to improve the micrografting technique for rapid in vitro grapevine plantlet propagation using Flame Seedless scion and Freedom as rootstock. Explants obtained in vitro were cultured in MS media containing 0.4 mg L-1 BAP. For micrografting, six methods were used: sterile wire ties, sterile metal needle, wax, aluminum foil, gel, and callus. Data was collected on morphological and biochemical parameters in micrografts produced using various procedures. With various degrees of success, all in vitro micrografting procedures successfully produced grafts. The best results of morphological parameters were recorded in micrografting in wax method with the highest survival (83.88%), number of shoots/explants (1.77), shoot length (1.66 cm), leaves/shoot (4.55), rooting (58.20 %), root length (1.27 cm). In contrast, the callus method had the least value for these parameters. Wax and aluminum foil methods were found to be a promising alternative to traditional grapevine propagation methods in the study.

Efficacy of Two-Stage Meek Micrografting in Patients With Severe Burns.

Burns are common injuries associated with high disability and mortality. In recent years, Meek micrografting technique has been gradually applied for the wound treatment of severe burns. However, the efficacy of two-stage Meek micrografting in patients with severe burns keeps unclear. The data of eligible patients with severe burns who were admitted to Southwest Hospital of the Third Military Medical University from January 2013 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the Meek micrografting method: one-stage skin grafting (group A) and two-stage skin grafting (group B). The baseline data, survival rate of skin graft, length of hospital stay, treatment costs, laboratory data, and cumulative survival were statistically analyzed. One hundred and twenty-seven patients (91 in group A and 36 in group B) were included in the study. There was no significant difference in the baseline data, the length of hospital stay, and treatment costs between the two groups. The survival rate of skin graft was higher in group B. Total protein and albumin level, platelet count in group B were superior to those in group A, while there was no difference in other laboratory data (prealbumin, serum creatinine, urea nitrogen, cystatin C, blood cultures, wound exudate cultures), and cumulative survival between the two groups. Our results demonstrated that staged Meek micrografting could improve the survival rate of skin graft, by reducing the risks of hypoproteinemia, hypoalbuminemia, and low platelet counts after adequate resuscitation.

Micrografting in Arabidopsis Using a Silicone Chip.

The micrografting technique in the model plant Arabidopsis has been widely used in the field of plant science. Grafting experiments have demonstrated that signal transductions are systematically regulated in many plant characteristics, including defense mechanisms and responses to surrounding environments such as soil and light conditions. Hypocotyl micrografting is a powerful tool for the analysis of signal transduction between shoots and roots; however, the requirement for a high level of skill for micrografting, during which small seedlings are microdissected and micromanipulated, has limited its use. Here, we developed a silicone-made microdevice, called a micrografting chip, to perform Arabidopsis micrografting easily and uniformly. The micrografting chip has tandemly arrayed units, each of which consists of a seed pocket for seed germination and a micro-path to hold hypocotyl. All micrografting procedures are performed on the chip. This method using a micrografting chip will avoid the need for training and promote studies of systemic signaling in plants. Graphic abstract: A silicone chip for easy grafting.

Acceleration of Skin Wound-Healing Reactions by Autologous Micrograft Tissue Suspension.

Background and objectives: Skin grafting is a method usually used in reconstructive surgery to accelerate skin regeneration. This method results frequently in unexpected scar formations. We previously showed that cutaneous wound-healing in normal mice is accelerated by a micrograft (MG) technique. Presently, clinical trials have been performed utilizing this technology; however, the driving mechanisms behind the beneficial effects of this approach remain unclear. In the present study, we focused on five major tissue reactions in wound-healing, namely, regeneration, migration, granulation, neovascularization and contraction. Methods: Morphometrical analysis was performed using tissue samples from the dorsal wounds of mice. Granulation tissue formation, neovascularization and epithelial healing were examined. Results: The wound area correlated well with granulation sizes and neovascularization densities in the granulation tissue. Vascular distribution analysis in the granulation tissue indicated that neovessels extended and reached the subepidermal area in the MG group but was only halfway developed in the control group. Moreover, epithelialization with regeneration and migration was augmented by MG. Myofibroblast is a known machinery for wound contraction that uses α-smooth muscle actin filaments. Their distribution in the granulation tissue was primarily found beneath the regenerated epithelium and was significantly progressed in the MG group. Conclusions: These findings indicated that MG accelerated a series of wound-healing reactions and could be useful for treating intractable wounds in clinical situations.

Tissue regeneration: an overview from stem cells to micrografts.

Regenerative medicine represents a major challenge for the scientific community. The choice of the biological sources used, such as stem cells and grafts, is crucial. Stem cell therapy is mainly related to the use of mesenchymal stem cells; however, clinical trials are still needed to investigate their safety. The micrografting technique was conceived by Cicero Parker Meek in 1958. It is based on the principle that by increasing the superficial area of skin grafts and reducing the size of its particles, it is possible to cover an area larger than the original donor site. Stem cells are pluripotent cells that have the capacity to differentiate into all cell types and are self-renewing, whereas micrografts derive from a small fragment of an autologous tissue and exhibit limited differentiative potential compared with stem cells. Therefore, stem cells and micrografts cannot be considered equivalent, although in some cases they exhibit similar regenerative potential, which is the focus of this review. Last, stem cell therapies remain limited because of complex and costly processes, making them not very feasible in clinical practice, whereas obtaining micrografts is generally a one-step procedure that does not require any advanced tissue manipulation.

Free skin micrografts with cyanoacrylate as outpatient treatment for venous leg ulcers.

The present study describes an ambulatory, free skin micrograft technique with cyanoacrylate as a coadjuvant venous leg ulcer (VLU) healing strategy and its outcomes after one month. This prospective study involved Comprehensive Classification System for Chronic Venous Disorders (CEAP) stage C6 patients with good granulation tissue and negative culture results, consecutively recruited in January 2017 in the Hospital Clinico San Carlos. A skin micrograft was harvested from the anterior surface of the patient's thigh with a 0.4cm punch (0.12cm2). The graft was adhered to the ulcer bed with cyanoacrylate. Anti-adherent dressing and double-layer bandaging was applied, with weekly replacements. Measurements were obtained of the surface of the VLU and graft progression (in cm2) using a photographic grid. A total of 12 VLUs in 12 patients were included, with a mean treated surface of 20.32±13.9cm2. A total of 18 grafts were placed and all were found to be viable after one week. Average graft growth was not noticeable after one week but was found to be 0.25±0.08cm2 after week two, 0.41±0.98cm2 after week three, and 0.70±0.15cm2 after week four (p<0.001). There were no complications in the donor zone. The findings of this study show that free skin micrografting with cyanoacrylate as outpatient treatment for VLUs was simple, rapid and without complication in this study, and may contribute to its wider application in clinical use.

Superior long term functional and scar outcome of Meek micrografting compared to conventional split thickness skin grafting in the management of burns

IntroductionAutologous skin grafting is the mainstay of treatment in burn patients. Extensive full thickness burns remains a challenge to the burns surgeon due to the lack of autologous skin donor sites. The conventional split thickness skin grafting (SSG) and the Meek micrografting (Meek) technique are part of the armamentarium of the burns surgeon to curtail the challenge of paucity of donor sites. With advances in burn care, mortality rates of burn patients have reduced. As a result, with more patients surviving acute burn, there is a paradigm shift of research towards assessment of functional outcomes and quality of life of the burn survivors. As there is lack of research regarding the functional outcome of the Meek technique, this study was designed to examine the long term functional outcome of the Meek technique and SSG in burns. MethodA cross-sectional study was conducted in Hospital Universiti Sains Malaysia to assess patients with burns between 10 to 40% total body surface area (TBSA) and with at least one year after injury. The Burn Specific Health Score-brief (BSHS-B) was utilized to compare the functional outcome whilst the Vancouver Scar Scale (VSS) was used for comparison on the scar outcome of the two skin grafting techniques. ResultsForty three patients (Meek,15; SSG,28) were included. The mean current age (years old) of Meek and SSG was 24.7 (range, 7–75) and 25.9 (range, 7–65) respectively. The mean TBSA (%) of the Meek group was 26.7 (range, 13–40) while that of the SSG group was 16.1 (range, 10–32). A simplified domain structure was used for the BSHS-B questionnaire. The work and sexuality subscale were analyzed separately due to missing data. There mean scores of affect and relations was higher in Meek compared to SSG (Meek, 3.86; SSG, 3.75; p > 0.05). Function domain was also better in Meek compared to SSG (Meek, 3.88; SSG, 3.73; p > 0.05). The Meek group displayed superior scar outcome compared to SSG as evidenced by the statistically significant difference in score for the pigmentation, pliability, height and total VSS score. ConclusionThe Meek group showed more favorable BSHS-B scores compared to the SSG group. The scar outcome of the Meek technique is significantly superior to SSG. Therefore, the Meek technique is superior in the management of burns because the long term scar and functional outcome of this technique is better compared to conventional SSG.

In-vitro micrografting technique in sweet orange (Citrus sinensis) cv. Blood Red to produce virus free plants

This study was carried out to assess the potential use and applicability of micrografting technique for the development of virus free nursery in sweet orange (Citrus sinensis Osbeck) cv. Blood Red Malta. The micro grafting was carried out using 11-20 days old etiolated seedlings of Rough Lemon, Sour orange, Carrizo and Karna Khatta rootstocks. An apical meristem (1-2 mm) having 3-leaf primordial (0.3-0.5 mm) were taken from the axillary proliferated nodal segments. Finely excised meristems were placed on aseptically grown rootstocks making an inverted 'T' incision in vitro. Micro grafts were inoculated on MS media added with different Plant Growth Regulators, i.e. IAA, NAA and 2,4-D each under varied concentrations (control, 0.1 ppm, 0.5 ppm, 1.0 ppm , 1.5 ppm, 2.0 and 3.0 ppm). Highest grafts success (60%) was recorded when 13 days old Carrizo seedlings were used as rootstock. Among all the treatments, scion treated with 2,4-D at 3.0 mg/l exerted maximum positive effect on the success of STG (70.00%). Overall, Sweet orange cv. Blood Red, micro grafted on Carrizo rootstock culturing on liquid MS media containing 2, 4-D at 3.0 mg/L resulted maximum success and growth of grafts. Successful micrografts were hardened under controlled conditions and further shifted in insect proof net house to develop disease free mother progeny.

Meek Micro-grafting Technique in Reduction of Mortality and Hospital Stay in Patients With Extensive Burns in a Resource Constrained Setting

Burns contributes to significant mortality. Among reasons for high mortality is inadequate burn wound management especially in patients with extensive burns and limited donor sites. Majority of the resource constrained countries donot have allografts or tissue cultures that would enable prompt and easy cover ages of such wounds. Skin graft Harvesting techiques such as the Meek micrografts are considered expensive and are thus not available. Patients with extensive burn wounds in many resource constrained countries as a result of this do have poor outcomes with high mortality and prolonged hospital stay. This was a prospective study on patients with extensive burns operated on with theMeek micro-grafting technique in a tertiary teaching Hospital in Kenya. Variables analysed included, total burn surface area, sessions of skin grafts, length of Hospital stay, donor site morbidity and mortality. Twenty five patients with extensive burn wounds were managed with the micro grafting technique over the last three years. The mean total burn surface area for the patients was 46.7 percent with the range of 24 to 72 percent. Five patients died while undergoing treatment giving a mortality rate of 20 percent compared to a mortality rate of 35 percent reported in our centre for patients with the similar burn surface area operated on with the mesh technique. The mean length of Hospital stay was 73.92 days compared to a Hospital stay length of 97.4 days previously reported prior to this technique. The mean donor size surface area was 15.8%. The average length of time the donorsite wounds healed was 16.7 days. Three patients had wound sepsis at the donor site that healed after dressing with silver based dressing materials. Meek micro grafting technique allows for extensive coverage of burn wounds with a relatively small donorsite. The technique is associated with reduced donor site morbidity, mortality and length of Hospital stay. This technique should be encouraged in many burn centers in developing countries where there are patients with extensive burn wounds.

Outcome of the Modified Meek Technique in the Management of Major Pediatric Burns.

The modified Meek micrografting technique has been used in the treatment of severely burned patients and a number of articles have examined the use of the modified Meek technique in adults and in mixed-age groups. However, there is a paucity of research pertaining to the outcome in the pediatric age group. The aim of this study is to present our favorable outcome in pediatric major burns using the modified Meek technique. A retrospective review of burn cases in Hospital Universiti Sains Malaysia from 2010 to 2015 was conducted. Cases of major burns among pediatric patients grafted using the Meek technique were examined. Twelve patients were grafted using the Meek technique. Ten (91.7%) patients were male, whereas 2 (8.3%) were female. The average age of patients was 6 years (range, 2-11 years). The average total body surface area was 35.4% (range, 15%-75%). Most burn mechanisms were due to flame injury (66.7%) as compared with scalds injury (16.7%) and chemical injury (16.7%). There was no mortality. All patients were completely grafted with a good donor site scar. The average graft take rate was 82.3%, although 8 cases had positive tissue cultures from the Meek-grafted areas. The average follow-up duration was 3.6 years (range, 1.1-6.7 years). Only 1 case developed contracture over minor joint. The Meek technique is useful when there is a paucity of donor site in the pediatric group. The graft take is good, contracture formation is low, and this technique is cost-effective.

Meek micrografting history, indications, technique, physiology and experience: a review article.

Traumatic loss of skin, particularly in major burns, requires skin grafting to repair the tissue. For a large burn, where donor sites are limited, the skin graft may need to be expanded. In addition, rapid wound closure is a large factor in successful recovery and is usually achieved by debridement and skin grafting. Micrografting was introduced by Meek and involved dividing the skin into small pieces, allowing for up to a tenfold skin expansion. We conducted a review of the literature, searched via Medline, Pubmed and Embase (from 1958 to June 2017), searching to identify studies and reports of micrografting. We searched using the Medical Subject Headings (MeSH) 'micrograft', 'micrograft technique', 'Meek', 'Meek technique', 'Parker Cicero', 'major burn treatment' and 'mesh skin graft'. We analysed 24 articles in which the description and modifications presented by the micrograft technique were presented, along with evidence that supports or rejects its use. The consensus was for the use of micrografting in burns of >30% total body surface area (TBSA). On poor wound beds, the evaluation of re-epithelialisation had greater success due to low metabolic demands and greater skin coverage compared with control groups (p<0.005). Comparing the 'mesh' with 'Meek' group, the micrograft group had fewer surgeries (10 versus 19.75), shorter average length of hospital stay (51 days versus 120.5 days; p<0.05). Micrografting can be used where there is poor bed vascularity (such as in patients with diabetes), with higher success due to low metabolic demand. This is recommended for major burns, >30% TBSA, with inadequate donor sites and comorbidities, such as diabetes. However, disadvantages include a 'polka dot' appearance on healing and the fact the initial surgeries, creating the micrograft squares, are labour-intensive.

Melanocyte transplantation – a variation of the micrografting technique

Vitiligo is an acquired pigmentation disorder characterized by the development of well-defined achromic macules in the skin. It is deemed stable when no new lesion emerges or when pre-existing lesions do not undergo changes for at least one year. In these cases, surgical treatment is an important therapeutic option. Punch micrografting is the most commonly performed melanocyte transplantation technique, resulting in excellent repigmentation. The authors describe a variation of this technique using even smaller and finer grafts (consisting of epidermis and thin dermis), in order to achieve aesthetical outcomes that are better than those obtained with the traditional technique, especially when treating areas with significant aesthetic impairment.