摘要：

INTRODUCTION. The management of burn injuries over 50% of the body surface area requires a reliable and reproducible strategy to enhance healing and obtain satisfactory outcomes. This paper explores the application of Meek Micrografting and a bioabsorbable scaffold as a comprehensive treatment approach for these patients at an American Burn Association verified Burn center. METHODS. All patients admitted with full thickness flame burn injuries over 50% TBSA who underwent application of the bioabsorbable scaffold (BS) and Meek micrografting over a two- year period, were included in the study. Data collected included patient demographics, co-morbidities, mechanism and extent of burn injury, surgical approach and hospital course, as well as complications. RESULTS. Eleven adult patients were included in this retrospective study (Table). Their mean age was 43.2 years (range 21-72 years) and all but three were male. Their mean TBSA burn was 61.2% (range 50 -74%), with Inhalation injury grade of 2.1 and Baux score of 108.3 (range 86-137). Mean length of stay was 66.5 days (range 44-80), and 8.3 surgeries (range 6-12) were undertaken. Tracheostomy was performed at a mean of 17.2 days. The Meek surgery was usually the final surgery and was performed at a mean of 42.1 days (range 35 – 53 days) after admission. The BS and Meek strategy covered almost half of the burn surface area (mean 29.5% TBSA, or 45.5% of the burn). The 3:1 expansion ratio was used in all patients. The average operative time used per % TBSA covered decreased over the period, with 15.18 minutes per % TBSA during the initial five cases, and 10.8 minutes during the second six cases (p = 0.03). One patient required partial removal of the BS for MRSA infection. Micrograft take exceeded 90% in all cases, and no further autografting was undertaken. All but one of the patients survived to discharge after a period of inpatient rehabilitation. CONCLUSIONS. The bioabsorbable scaffold (BS) provides Meek micrografts with a stable, homogenous, well vascularized and therefore receptive wound bed. We present a series of eleven patients with extensive burns who received the combination of these two strategies to good effect. APPLICABILITY OF RESEARCH TO PRACTICE. With greater experience, burn operating teams can reduce operative time per TBSA covered and obtain excellent outcomes using 3:1 Meek on the wound bed provided by the boabsorbable scaffold. FUNDING FOR THE STUDY. N/A

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