• Si Jack Chong, Abby Choke, and Bien-Keem Tan.
• Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
• Burns. 2017 Aug 1; 43 (5): 983-986.

AbstractThe lack of autograft donor site is one of the greatest limiting factors for the treatment of extensive burn. Micrografting is an important revolution in burn surgery where autografts are cut into small pieces for wide and rapid coverage of burn wound. Our early experiences with the current standard micrografting technique were fraught with poor graft take as well being time and labor intensive. We have improvised our technique, where we combined the use of allograft to serve as a carrier for the micrograft. The objective of this paper is to share our experience in micrografting and several technical tips which had enhanced our micrografting results. The improvisation in our technique includes: (1) Single-stage 'micrograft-allograft sandwich method' where allograft served as a direct carrier for the micrografts. Micrografts were laid uniformly 1cm apart onto allograft sheets, creating a 1:9 expansion ratio. This technique replaced the original two stage method. (2) The use of the Meek device (Humeca, Netherlands) to prepare micrograft. The Meek device can rapidly produce 3mm micrografts for easy transfer with a fine forceps. (3) The use of slow-acting fibrin sealant to promote graft take and hemostasis. (4) A two-team approach for micrograft preparation where one team processes micrograft and another prepares the allograft sheets. This reduces the lag time between micrograft preparation and grafting, and reduces the overall surgery time. Micrografting remains an important treatment for major burn surgery. The aim of micro-allograft combination is to allow autografts re-epithelization under a reliable temporary skin coverage in a single stage procedure. A prospective study is warranted to measure the objective outcome of this renewed technique.Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

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