Transversely meshed skin grafting for aesthetically sensitive areas

Abstract

Objective: Meshing of split thickness skin grafts (SSG) improves the chances of their `take` by allowing blood and exudates to escape. Traditional wide meshing has a major disadvantage of having a cosmetically compromised checkerboard or lizard skin appearance. For which reason they can not be used on aesthetically sensitive areas like head and neck and extremities. Unmeshed SSG does not ensure adequate drainage and at times results in poor `take`. Transverse meshing ensures better drainage and its cosmetic appearance is also comparable to that of unmeshed SSG. The objective of this study has been to analyze the advantages of this novel technique in skin grafting and see its efficacy over un-meshed grafts. Design: An original article based on a prospective, observational study. Methodology: A total number of 69 patients were studied between October 1999 and April 2003. Both male and female patients of all age groups were selected, ranging between 11/2 and 70 years. Patients selected for skin grafting inc luded those with wounds caused by burns, degloving injuries of the scalp, genitalia, hands and feet and post burn contractures of the neck and extremities, and flap donor sites (see table below). Skin grafts were harvested with a pneumatic dermatome. A mesher board of 1.5: 1 expansion was cut into two equal halves which were placed side by side with the grooved side up. Skin grafts were applied and secured in the standard fashion. The patients were followed up on outpatient basis. Results: Graft success rate was 93% with acceptable cosmetic appearance. There was a total loss of two grafts (2.7%) and partial loss of three (4.3%). The healing of the graft was excellent. Conclusions: Transverse meshing is a new technique in meshed skin grafting with improved `take` and acceptable cosmesis as compared to unmeshed skin grafts. This technique can obviate the need for two- stage skin grafting for areas where wide meshing is not desirable.