Nikkhah D, Booth S, Tay S, Gilbert P, Dheansa B, et al.
Burns : journal of the International Society for Burn Injuries. Date of publication 2015 Mar 1;volume 41(2):257-64.
1. Burns. 2015 Mar;41(2):257-64. doi: 10.1016/j.burns.2014.07.023. Epub 2014 Aug 28.
Comparing outcomes of sheet grafting with 1:1 mesh grafting in patients with
thermal burns: a randomized trial.
Nikkhah D(1), Booth S(2), Tay S(3), Gilbert P(4), Dheansa B(5).
Author information:
(1)Plastic Surgery Registrar, East Grinstead Hospital, East Grinstead, UK.
Electronic address: dariushnikkhah@hotmail.com.
(2)Burns Researcher, Queen Victoria Hospital, East Grinstead, UK.
(3)Plastic Surgery Registrar, East Grinstead Hospital, East Grinstead, UK.
(4)Consultant Plastic and Reconstructive Surgeon, East Grinstead Hospital, East
Grinstead, UK.
(5)Consultant Plastic and Reconstructive Surgeon & Clinical Lead Burns Unit, East
Grinstead Hospital, East Grinstead, UK.
BACKGROUND: In many units, the standard mesh ratio is 1.5:1, but in our unit we
have a 1:1 mesher, which does not expand the skin but provides regular
fenestrations. There is some evidence that the unexpanded 1.5:1 meshed graft
compares favourably with sheet grafts from a cosmetic perspective whilst reducing
the risk of graft failure secondary to a subgraft haematoma, but none comparing
the 1:1 meshed graft with the sheet graft. We conducted a randomized trial to
compare surgical outcomes in unfenestrated sheet grafts with 1:1 meshed grafts.
METHODS: All patients aged ≥16 years undergoing skin grafts with either a sheet
or a 1:1 mesh for burn reconstruction were included. Patients on steroids, those
with conditions that impair healing, and burns >20% were excluded. Patients were
randomized into the sheet grafting or mesh graft using a computer-generated
allocation system. The mean percentage of graft loss was assessed by a Visitrak
overlay system. At 3-4 months, 7-8 months and at 1 year, photos were taken for
scar assessment using the Vancouver Scar Score (VSS).
RESULTS: Out of 72 patients, 48 patients (24 sheet vs. 24 mesh) completed the
trial at 12 months. The mean age was 58 years (range 21-90). There was no total
loss of graft in either group. The mean percentage of graft loss due to haematoma
formation was higher in the sheet graft group (10%) compared to the 1:1 mesh
group (6%) (P<0.062). The VSS score was 5 in both groups at 12 months. There was
no significant difference in scar quality between the treatment groups.
CONCLUSION: These results show that the 1:1 mesh graft is superior to the sheet
graft with regard to graft loss, although this result is not statistically
significant. There are comparable findings in terms of cosmetic perspective at 12
months post-operatively in both arms of the trial.
Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.
DOI: 10.1016/j.burns.2014.07.023
PMID: 25175303 [Indexed for MEDLINE]
