Micrografting in Major Burn Treatment-Experience of Taichung Veteran General Hospital

Background: The most difficult problem in major burn treatment is the lack of an autograft donor site. In 1958, Meek devised a technique that used widely expanded postage stamp autografts. Kreis modified Meek's technique in 1993 and called it ”micrograft”. Since then, the micrograft technique has been commonly used for patients with major burns. Aim and Objective: Generally, the scarring from micrografting is severer than that from traditional meshed graft. However, discussion in this concept is few in the past. In this study, we reviewed 10 cases of patients with major burn wounds and compared the quality of the scars from the two grafting techniques used. Materials and Methods: From Sept. 1999 to Sept. 2006, 10 patients received micrografting treatment in 15 separate operations in Taichung Veteran General Hospital. The mean age of these patients was 30.1 years (range: 19-47 years). The mean burn area was 67.8% TBSA (range: 24-90% TBSA). The expansion rate varied from 1:4 to 1:9. The mean follow up time was 25 months (range: 5-65 months). Results: To increase the graft survival rate and control infection in all our patients, we used three procedures: 1) expanded pre-folded gauzes were punctured several times before application, 2) the external dressing was changed on the first post-operation day, and 3) silver sulfadiazine was applied daily from the 7th post-operation day. In the 15 micrografting treatments, the mean area grafted per procedure was 1799±747.4 cm^2 (range 847-3810 cm^2). The mean graft survival rate was 82.6%. The mean number of dampened cork plates used was 16, and the mean cost of cork plates per operation was NT$32000. In the follow up periods, the mean Vancouver Scar Scale was 5.27±1.9 (range 3-8). The mean score of scar pain was 0.63±2.1. We also evaluated the scarring from the traditional meshed skin grafts at the same time in four patients. The mean Vancouver Scar Scale was 7±1.6 from meshed skin graft and 7±1.4 from micrograft. The mean pain score was 3.25±2.4 from meshed skin graft and 0 from micrograft. Conclusion: In the same patient with same condition of burn wounds, there was no obvious difference in scar severity between the micrograft and meshed graft.