Fig. 8. Autologous split-thickness skin grafts.

For a patient with a severe burn injury to survive, the burn wounds need to be excised and covered. Temporary measures using allograft or various biological substitutes are available but, at this time only the patient’s skin (autologous) can permanently accomplish coverage. Several graft methods are available to cover burn wounds using autologous skin. a | Sheet grafts are the most aesthetically pleasing but require a lot of skin to cover wounds and, therefore, are usually reserved for small burns or for skin grafts to complex and important areas such as the face, hands and breasts. Full-thickness sheet grafts are reserved for smaller defects (usually lower eyelids and re-occurring upper eyelids) and play a more important part during the reconstructive phase. These are harvested using a dermatome. A split-thickness graft can be placed as a sheet graft or used for meshing. b | Use of meshed split thickness skin grafts is usually the method of choice to cover larger areas. The goal of meshing skin is to expand the donor skin to obtain greater coverage; skin can be meshed in ratios of 1:1.5, 1:2, 1:3, 1:4 or 1:6. Although increased meshing increases the coverage size, meshed skin becomes increasingly fragile. c | An alternative technique is the Meek technique, in which skin squares can be spread out to a large extent and added to the wound bed, covering large areas (up to a ratio of 1:9). This technology is reserved for extensive burns for which donor sites are sparse. d | A freshly meshed split-thickness skin graft (left) and its healing over time (right). Images in part c courtesy of R. Nijlant, Humeca B.V., Netherlands.