Brochure MEEK Micrografting - Humeca

Axilla and upper arm 21 days post burn,before operationmeek caseGauze applied to the wound (upper arm)Gauze secured with staplesBy dr. A.W.F.P. Vloemans, surgeonat Red Cross Hospital Beverwijk,The NetherlandsAn 84 years old woman was admittedin our burns centre because of a burnwound she sustained in the kitchen.While taking a kettle from the gasstove her nightgown caught fire. Atfirst she did not notice, but after awhile she saw her clothes burning.She put out the flames and cooledthe burns under the shower.On admission we saw a healthyobese woman with burns at theright upper arm, axilla and thorax.The total body surface area burnedamounted 11%; about 9 % fullthickness. The borders between fullthickness and partial thickness werenot sharp.The medical history recordedinsulin dependant diabetes and astroke. As medication she also usedacetylsalicylic acid.Topical treatment consisted of dailyapplication of Silver Sulfadiazin 1%cream dressings. Resuscitation wasapplied by means of an isotonicsaline solution and fluids ad libitum.Insulin medication was continuedbased on blood sugar levels and alsotreatment with acetylsalicylic acidwas continued.As an early tangential excision wasexpected to cause a great blood lossand as the distinction between partialand full thickness was not clear, asecondary excision and grafting afterhealing of the partial thickness burnswas performed.Operation took place on postburn day 21; five days earliertreatment with acetylsalicylic acidwas discontinued. The wound bedconsisted of granulation tissue andremainders of necrotic dermis. Debriswas excised using a dermatome.Haemostasis was performed bymeans of the application of anadrenalin solution to the excisedwound bed.A thin split thickness skin graft washarvested from the right upper leg.Ten Meek gauzes 1:6 were preparedand applied to the wound. Afterfixation with staples the wound wascovered with gauzes soaked in asilvernitrate solution. The donorsitewas dressed with polyurethane foamdressing.After 6 days the MEEK gauzes wereremoved from the wound. The grafttake appeared to be about 80%.Two weeks after the first operation,parts of the wound where the grafthad not taken because of insufficientexcision at the first operation, wereexcised again and grafted with Meekgauzes 1:4. Parts of the wound witha good graft take, but insufficientoutgrowth of epithelium were alsore-grafted.After the second operation only minordefects remained, requiring only dailyapplication of a topical antibacterialdressing. Five weeks post burn thepatient was released from hospital.Gauzes and parts of gauzes on the woundInitial result after the first transplantationRe-grafting: a gauze is cut into piecesto graft smaller areas on the thorax7