User manual in English - Humeca

MEEK – MicrograftingManualCylindrical motor and hand drive11/01

General remarkThis manual describes how the MEEK technique is performed in textand pictures.For a better understanding of the procedure we strongly advise youto watch the MEEK instruction films that comes with each machine.These films clearly show the MEEK procedure, from assembly of themachine until healing of the burn wound.Additional copies of the DVD are available from Humeca or your localdealer.Warning:Always pay attention to the presence of very sharp blades in theMEEK machine. Please handle them with care to prevent cuttingaccidents!

Contents3I. Mounting and dismounting the machine1. Assembly of the machine 41a. Placing the pneumatic motor 41b. Connecting the air hoses for pneumatic drive 51c. Placing the hand drive 52. Lubrication 53. Sterilization and cleaning 6II.The Micrograft-procedure1. Determining the expansion factor 82. Harvesting the graft 83. Preparing the skin before cutting 94. Placing the cork with the graft into the cutting block 95. Cutting 105a The first cutting 105b The second cutting 106. Applying adhesive to the autograft 117. Transferring the graft to the gauze 118. Extending the gauze 129. Removing the fabric from the wound 1210. Local therapy 1311. Trouble shooting 14III. Service 18IV. Ordering 19V. Supplier 20Pictures 21-33

4I. Mounting and dismounting the machineSee fig. 1 and 2. The machine consists of a cutting block 1, aframe 2 and a pneumatic motor in a cylindrical casing 3, or ahand drive. Rotation of a handwheel 4 causes the cutting block 1to move under a bridge 12 where 13 circular blades cut throughthe skin.Attention: Do not sterilize the motor !!1. Assembly of the machineCheck whether the blades axis 10 is in its right position, asshown in fig. 2: the bearings should be in their seats and thecoupling 15 should point to the left side, when facing thehandwheel side of the machine. Place the bridge cover 12 (fig.1) on the frame and fasten the bolts 11 by hand.1a. Placing the pneumatic motorThe procedure to be followed for placement of the motor on themachine is illustrated in fig. 3-9.Because the motor is not sterilized, it is encapsulated in a sterilecylindrical casing (fig. 3). A circulating nurse places the unsterilemotor 22 into the sterile casing 3, that is held in position byauthorized personnel. The motor is placed in the casing in sucha way that the cam 22a comes in the groove of the casing, asshown in fig. 4 and 5. Now place the casing with the motorinside on the machine and push the coupling hull 15a of themotor over the coupling hub 15 of the blades axis (fig. 6). See toit that the casing 3 fits precisely in the groove 14 of the bridge.The hole 3a in the cylindrical wall of the casing should be at theupper side (fig. 7). Close the clamp 10. The cam 10a of theclamp should come into the hole 3a of the casing wall (fig. 8). Ifclamp 10 cannot be closed, either the hole 3a is not in the rightposition, or the casing 3 is not pushed into the groove 14 of thebridge. After closing clamp 10, fasten motor bolt 9 (fig. 9; pushand turn a quarter). The motor is taken off by acting the otherway round.

5Attention:Beware that the motor doesn’t fall out of the casing!1b. Connecting the air hoses for pneumatic driveThe procedure is illustrated in fig. 10-14.The foot pedal has two connections (fig. 10). One air hose isalready fastened to a connection. Connect the other end of thathose to the motor inlet 22b by pushing the quick connector 8over it (fig. 11 and 12). Because there is a large variety in hosediameters and connectors in use at hospitals internationally, wecannot supply the air hose between the foot pedal and thepressure system in the operating room. Please arrange asuitable hose for that purpose yourself. We’re happy to assistyou if necessary. It is also possible to use an air cylinder insteadof the wall outlet. Connect the hose from your pressure systemto the other connection of the foot pedal by means of quickconnector 24; see fig. 13. This quick connector is fixed to thehose with a hose-clamp. Connector and hose-clamps of differentsizes are supplied with the machine. See fig. 14 for instruction. Apressure of about 6 bars is recommended. Do not exceed 8bars. The apparatus is now ready for use.1c. Placing the hand driveThe procedure for placing the hand drive on the machine isillustrated in fig. 15-17.Place the coupling hull 15a of the hand drive over the couplinghub 15 of the blades axis and place the white polymer disk 20 inthe opened cylindrical support (fig. 15). The hole 20a in the diskshould be at the upper side. When closing clamp 10, the cam10a should come into the hole of the disk (fig. 16). Fasten bolt 9(push and turn a quarter, fig. 17). The hand drive is taken off byacting the other way round.2. LubricationTo grease the bearings of the blades axis and spindle werecommend to put a drop of oil into the holes indicated with ared circle in fig. 19. Also put a drop of oil on the half nut at theunderside of the cutting block (fig. 18). In case of pneumaticdrive, we also advise to put a drop of oil into the inlet of the

6motor once every 3 months. Humeca supplies AesculapSTERILIT ® oil for that purpose.3. Sterilization and cleaningTake out the motor. Beware that it doesn’t fall out of the casing!Attention: Never sterilize the motor !!The entire Micrograft cutting machine can be cleaned and steamsterilized, except for the motor. Autoclaving occurs at a commontemperature of 134 o C (usually 5-10 minutes) or 121 o C(prolonged exposure time of approx. 20 minutes).If necessary, clean the blades by hand from skin remnants andblood immediately after use. To that end loose the two screws11 (fig. 1) and lift off the cover 12 of the bridge. Take out theblades axis, clean it with water and a soft brush and replace it inthe machine.Attention!!!Never touch the blades with your fingers!They are extremely sharp. Never touch theblades with some hard object nor place themon a hard surface. They’ll be damaged.Also the inside of the cutting block cover has to be cleaned byhand sometimes. Because this surface contacts the skin duringcutting, on the long term a sticky layer (biofilm) might be formed.If persistent, this layer has to be removed mechanically by hand.Fig. 20and 20A show how the different parts of the MEEKmachine can be placed in the MEEK sterilization case 3.MAC02.If you use a different case, please leave the blades axis inposition on the machine during washing and sterilization (asshown in fig. 2) in order to prevent damage. Alternatively, youcan put the blades axis separately in the small sterilization case3.MAC03 (fig. 21) that Humeca supplies for this purpose. Thecutting block 1 and the serrated wedge 17 are placed next to themachine during sterilization.

Some additional remarks regarding cleaning andsterilizationThe MEEK machine consists of anodised aluminium andstainless steel. The least damage to coloured and non-colouredanodised aluminium is observed when neutral cleaning agentsare used in combination with demineralised water. The quality ofwater in the cleaning process is of crucial importance. Anunfavourable water composition can have a detrimental effect onthe materials of surgical instruments.Strong alkaline cleaning agents will cause visible changes to thesurface of the instrument, like stains and color fading.Hot air drying temperatures higher than 90 o C should be avoidedto prevent crazing of the anodized surface. Do not use H 2 O 2(hydrogen peroxide) in the washing process, as it will damagethe instrument.A recommended procedure for cleaning and sterilization andadvisory on cleaning agents to be used is presented in a jointpublication of Humeca and Johnson Diversey. It is provided witheach instrument and available on request. You can alsodownload it from www.humeca.nl/downloads.7

II. The Micrograft-procedure81. Determining the expansion factorBefore harvesting the autograft from the patient, the expansionfactor is determined.In low- and medium-sized burns, there is no lack of donor sitesand thus no large expansion is required. In these cases anexpansion factor of 1:3 or 1:4 is enough for quickepithelialisation. In extensive burns however, the 1:6 expansionis recommended and only in extreme cases of very high TBSAburns a 1:9 expansion is required.Compared to meshgrafts the quantity of graft required in theMEEK technique is about half as much. Once the expansionfactor is determined, the total donor site area can be roughlycalculated and the graft is taken from the patient.The expansion factor is clearly printed on the peel pouch of eachgauze and it is also indicated on the gauze itself (in one of thecorners the expansion 3, 4, 6 or 9 is relief- printed in thealuminium foil).2. Harvesting the graftBefore harvesting the graft, the skin of the patient is oftengreased with some oil to enable a smooth run of the dermatomeover the skin. However you should not to do this when using theMEEK technique, because the oil prevents good adhesion of thegraft islands to the fabric. Use water or buffered salt solutioninstead, so:Attention!! When applying the MEEK technique, don’tuse oil or any other fatty substance whenharvesting the graft from the patient !!

3. Preparing the skin before cutting9In the MEEK technique the expansion is realized by means of apre-folded gauze (fig. 21). Each gauze is supplied with a corkplate measuring 42x42 mm (1.65x1.65”) (fig. 22) and packedsterile in a peel pouch. Take the cork plate out of the pouch andsubmerge it into water shortly. The cork plate now has to becovered with a piece of split skin graft of the patient with thedermal side facing the cork. To this end spread a strip of splitskin graft, epidermal side down, on a smooth surface, like aplasticized sterile cloth or the smooth side of a meshgraft carrier.Then place the cork plate on the graft and trim the graft to thesize of the cork plate. The MEEK-video clearly shows how this isdone in practice. If the graft strip was harvested with theHumeca D42 dermatome, the width of the strip equals the widthof the cork plate, which makes it much easier to cover it. Thecork plate covered with graft is shown in fig. 23. Smaller graftremnants can also be used by placing them on the cork platelike a "puzzle" (fig. 24), so there is no spillage of graft, which isan advantage in case of extensive burns.Attention!! The autograft should be trimmed to thesize of the cork plate. It should not belarger than the cork plate!4. Placing the cork with the graft into the cuttingblock.Place the cork square on the cork holder 18 and put it in therecess of the bottom of the cutting block (fig. 25). Moisten theunderside of the cover with water or buffered salt solution toprevent sticking of the graft to the cover after cutting. Close thecover and lock with bolts 19, see fig. 26.

5. Cutting105a The first cuttingPlace the cutting block on the guiding axes of the cuttingmachine at the side of the handwheel (fig. 27). This can only bedone in one way because the guiding axes differ in diameter.- In case pneumatic drive is used:Switch on the motor with the foot pedal and turn thehandwheel. The cutting block is now moved under the bridgewhere the rotating 13 blades cut the graft into 14 stripes.- In case hand drive is used:Turn the handle of the hand drive clockwise while someoneelse turns the handwheel to move the cutting block under thebridge.Attention!!Always move the cutting block from the sideof the handwheel to the other side; neverreverse (fig. 27).When the cutting block has reached the end of the guiding axesit can easily be taken off from the machine. Open the bolts 19,and place the serrated wedge 17 in the middle of the grating inthe cover (fig. 28). Now push the serrated wedge downwards,while lifting up the cover a little (fig. 29). Open the cover (fig. 30).The graft should remain on the cork plate.In case a double cutting block (fig. 31) is used, the serratedwedge is pressed into both gratings before opening the cover.5b The second cuttingTurn the cork holder (18) a quarter and put it back in the cuttingblock. Moisten the underside of the cover again, close it and lockit. Put the cutting block on the guiding axes at the side of thehandwheel once again and switch on the motor or start turningthe hand drive. Now the cutting block is passed under the bridgeonce more, and the graft is cut into 14x14 = 196 squares. Openthe cutting block, using the serrated wedge as mentioned beforeto prevent sticking of the graft to the cover and take out the corkplate with the graft (shown in fig. 32).

116. Applying adhesive to the autograftPlace the cork square with the cut autograft on a flat surfacecovered with a sterile cloth or some other disposable material.Spray glue on the epidermal side of the graft from a distance ofabout 25 cm (10 inches) and allow to dry for at least 6 minutes(the surface must change from glossy to dull). A longer dryingtime does not harm.Attention!!- Allow the glue to dry for at least 6 minutes!(some more drying time is even better)- Don’t spray more glue than necessary to makethe surface of the graft glossy. Excess quantityof glue requires longer drying time!7. Transferring the graft to the gauzePut the gauze on a flat surface, foil side down. Place the corkplate with the autograft downwards, on the central pleated areaof the gauze (as indicated in fig. 33). Press firmly and then peeloff the cork plate. The grafts should now adhere to the gauze(fig. 34). If the grafts still adhere to the cork plate, either thedrying time for the glue was not sufficient, or some fattysubstance (paraffin oil) was used on the patients skin duringharvesting of the graft.Note:It is recommended to keep the grafts moistened in case you donot immediately transplant them to the patient. If desired youcan build up a stock of gauzes before transplantation. Cover thegauzes with wet gauzes. You can keep them un-expanded untiltransplantation.

8. Extending the gauze12Hold the gauze at the two notched sides and pull until the gauzeis completely unfolded in this direction (fig. 35). Now hold thegauze at the other sides and pull until the gauze is unfolded inthat direction too (fig. 36). Peel off the aluminium backing. Trimthe margins or fold them double down. Then apply the fabric,graft side down, to the wound bed and secure it with surgicalstaples (fig. 37). In this way all the gauzes with graft islands areplaced on the wound adjacent to each other (fig. 38). If desiredthe gauze can be cut to graft smaller areas (fig. 39).Apply vaseline gauzes with antibacterial cream to cover thegrafts and wrap with bandages. Keep undisturbed for the firsttwo days and then refresh every day until day 6.Alternatively the grafts can be covered with some wounddressing that slowly releases an antibacterial agent, like silverions. In that case refreshing the dressings might not benecessary.9. Removing the fabric from the woundSix days post-grafting the grafts have grown sufficiently into thewound bed to allow removal of the fabric (fig. 40). The staplesare removed and, using blunt forceps, the fabric is gentlydetached, leaving the graft islands in situ on the wound bed.Sometimes antibacterial cream is put on the fabric on day 5, asit facilitates removal of the fabric on day 6. Don’t tear off thefabric at right angles to the wound; instead peel it off, as shownin the picture below.not like this.....but like this

10. Local therapy13We like to point out that the following is only a suggestion: offcourse you can follow your own experiences and attune them tothe MEEK method. In fact there is not much difference betweenlocal therapy after MEEK grafting and mesh grafting. The maindifference is the presence of a fabric immediately after graftingin case of MEEK.For a good graft take it is essential that the wound bed is keptmoist after transplantation. Mostly the MEEK gauzes are firstcovered with a non adherent gauze with antibacterial cream.Then a layer of gauzes, sometimes soaked in an antibacterialsolution (like for instance 1% betadine in aquadest) is applied.Immerse gauzes into the antibacterial solution of choice,squeeze them by hand and place them on the wound. Finallywrap bandages around the affected area. For the first 2 daysthe wound is kept undisturbed to avoid movement of the graftislands. After that period, dressings are refreshed daily.Alternatively the grafts can be covered with some wounddressing that slowly releases an antibacterial agent, like silverions. In that case daily refreshing of dressings is not required.When the Micrograft gauzes are not removed after six days,epithelialization continues normally under the gauzes. So, ifdesired, removal can be delayed to a later stage...Sometimes, after removal of the MEEK gauzes, allografts,meshed 1:1,5 are put on top of the islands (so called “sandwichgrafting”). This is only useful in case of a clean wound and onlyafter primary excision. Allografts are mainly used at expansionratio 1:9. When the expansion ratio is 1:6 or less, allografts arenot needed.Sometimes the MEEK technique is repeated on small parts ofthe wound, particular to supply new granulation tissue with graftislands.If too much graft was taken from the patient, the surplus can bestored in a refrigerator for at least a week for additional grafting.Fig. 41 shows the result of MEEK grafting on the back of apatient shortly after complete epithelialization.

11. Trouble shooting14Problem Possible cause SolutionMotor does not runAir leakageAir pressure too lowRotation of blades axisblockedCheck all hose connections andrepair if leakage occursIncrease air pressure to at least 4barsRemove the motor from the axis.Check whether the blades axiscan be run by hand easily (rotatethe coupling on the axis). If not,remove the bridge, apply oil to thebearings and try again. If rotationstill blocked, contact supplier. Ifrotation only blocked when thebridge is placed, contact dealer.Motor runs, but bladesdo not rotateCutting block does notfit on the guiding axesor it moves too heavyMotor defectBolts on the blades axisare loose. In that casethe axis rotates, but theblades don’t (duringcutting)Coupling on the motor isloose. In that case thecoupling rotates, but theblades axis doesn’t.Screws at the end of theguiding axes are loose,or for some otherreason, the position ofthe guiding axes hasbeen changed.Take motor out of the machineand connect it to the air supplyvia the foot pedal. Switch on,while pressure is at least 4 bars.If the motor does not run, tryhigher air pressure (do notexceed 8 bars). If motor still doesnot work, contact dealer.Fasten the two bolts on theblades axis (first fasten the boltthat is closest to the blades, thenthe other one).Take the motor out of the deviceand connect it to the air supplyvia the foot pedal. Switch on andcheck if the coupling on the motoris running (try to stop the couplingby hand while the motor isrunning; this should not bepossible). If the coupling is loose,fasten the screw in the couplingor if the screw is missing, order anew one.Humeca has to re-position theguiding axes. Send machine andcutting block to Humeca or dealerfor repair

Problem Possible cause SolutionSkin is not cut or onlypartly cutSkin sticks to the coverof the cutting blockwhen it is opened,even after proper useof the cam andmoistening the cover.Skin moves on thecork plate duringcuttingGuiding axis orunderside of cuttingblock is damagedMovement of spindle orhand wheel is blockedWrong diameter of thebladesWrong thickness of thecork holderCork plate too thinBlades are bluntBlades or blades axis donot rotatePosition of guiding axischangedScrews of the bridgewere not fastenedproperlyA “biofilm” was formedat the underside of thegrating of the cover or itis polluted by othersubstances (like MEEKadhesive).The graft was too thick:it not only consists of anepidermal and a dermallayer, but also a layer offatty tissue was taken.The fatty tissue is veryslippy and it causes thegraft to move duringcutting15Check if there are any burrs onirregularities at the guiding axesor at the cutting block and removethem with sandpaperRemove the block from theguiding axis and rotate thehandwheel. If rotation is blockedor too heavy, apply oil and tryagain. If still problematic, contactdealer.Measure diameter of blades andcheck this info with Humeca,referring to the serial number ofthe machineMeasure thickness of cork holderat the edges and check this infowith HumecaMeasure the thickness of the corkplate. It should not be less than 2mm (0.08”)Take the blades axis out of themachine and look to the cuttingsides of the blades. These sidesshould not be shiny. If they are,replace the blades of replace theblades axis as a wholeSee sections above that relate tothat matterHumeca has to re-position theguiding axes.Fasten the two screws of thebridge and check whether or notthe bridge is positioned correctly.Clean the underside of the coverthoroughly (preferably with someabrasive liquid cleaner).Reduce the thickness of the grafttaken from the patient bymodifying the adjustment of thedermatome. If the graft wasalready taken off, scrub or cut thefatty tissue layer from the graftand repeat the MEEK technique.

Problem Possible cause SolutionMotor makes too muchnoiseThe drive of themachine is too heavy;the required work todrive the blades seemsto be too high.Movement of cuttingblock under the bridgeis blocked: the blockcannot pass under thebridge.Graft does not stick tothe prefolded gauze:after pressing the corkplate to the gauze andremoving it, the graft isstill on the cork plateinstead of sticking tothe prefolded gauze.The cover of the cuttingblock was not properlyclosedThe cutting block wasmoved under the bridgein the wrong direction.Sound reducer notpresent or defectAir pressure too highBlades axis runs tooheavy unloadedThe blades cut too deepinto the cork plateThe cork plate was notmoistened before useThe blades are bluntThe cover of the cuttingblock was not locked;the two screws riseabove the level of theblades axis.Not enough glue wasappliedDrying time of the gluewas too short16Check whether the cover islocked properly. Also check thesprings in the locks. If a springbroke, replace it.Always put the block on themachine at the side of the handwheel.Place a new sound reducer at therear side of the motorReduce pressure (max. 8 bars)Remove the cutting block and themotor from the machine and runthe blades axis by hand. It should“freewheel” easily. If not, pleasecontact your supplier for furtherassistance and trouble shooting.Place a cork plate in the machineand cut it. Check the depth of thecuttings. The depth should beapprox. 0.5 mm (0.02”). If it is farmore, please contact yoursupplier for further assistance.Immerse the cork plate in wateror physical salt solution beforeuse.Take the blades axis out of themachine and look to the cuttingsides of the blades. These sidesshould not be shiny. If they are,replace the blades of replace theblades axis as a wholeTake out the cutting block, closethe cover and lock itTry again, using more glue. Afterspraying, the whole surface of thegraft should have a glossyappearance.Allow the glue to dry for at least 6minutes (a longer drying timedoes not harm). When much gluewas applied, the drying timeshould be increased.

Problem Possible cause SolutionAfter unfolding thegauze, the graft islandsdo not separateproperly: a significantnumber of islands or acomplete row remainsunseparated whenunfolding the gauze.A fatty substance (likeparaffin oil) was usedduring harvesting of theskin to establish easyrun of the dermatomeThe graft was largerthan the cork plateThe cutting was notcompleteFar too much glue wasused. The gluepenetrated in the seemsbetween the graftislands and stuck themtogether.17Use water or physical saltsolution when harvesting the skin,but at no means use oil. Oilprevents the glue from sticking. Ifaccidentally oil was used, try toclean the epidermal side of thegraft with alcohol.Trim the margins of the graft tothe size of the cork plateSee section “Skin is not cut”aboveUse less glue

III. Service18- The Micrograft dermatome is guaranteed for two years,except for the blades. This guarantee implies free repair ofthe machine and accessories when used in a normal way. Ifproperly handled, replacement of the blades is onlynecessary after several years. They are coated with aceramic layer and can withstand thousands of cuttingprocedures. Of course blunt blades can be replaced by newones.- The management system of Humeca for design, productionand sales has been certified according to EN ISO13485:2003.- According to the European Medical Device Directory 93 / 42 /EEC the MEEK cutting machine come under the head ofclass I products.- The MEEK gauze is a Class I sterile product.- The CE-hallmark is indicated on the bridge of the machineand on the package of the prefolded gauzes.- Do not use other than Humeca blades in the cutting machine.- Do not use MEEK gauzes and/or cork plates in case thepackage is damaged.- The manufacturer considers being only responsible for thesafety and performance of the MEEK cutting machine, if it isused in the way as described in this manual. Forreplacements only original spare parts must be used.Replacements have to be carried out by the manufacturer orby one of his authorized local dealers.

IV Ordering19When ordering, please refer to the following article numbers:Equipment3.HD/BLO MEEK cutting machine, hand driven (block model) without cutting block3.HD/CYL MEEK cutting machine, hand driven (cylindrical model) without cutting block3.MD MEEK cutting machine, motor driven, without cutting block3.MD/GW MEEK cutting machine, motor driven, gearwheels, without cutting block3.MD/AUT MEEK cutting machine, automatic version (two axis motor driven)3.BL38 MEEK circular ceramic coated blade, diameter 38 mm3.BL39 MEEK circular ceramic coated blade, diameter 39 mm3.CA01 MEEK cutting aid 41x41 mm.3.CB01 MEEK single cutting block with cork holder3.CB02 MEEK double cutting block with two cork holders3.CH01 MEEK cork holder3.CP4 MEEK pneumatic foot pedal with connectors and hose3.KN13/38 MEEK cutting axis with 13 ceramic coated circular blades, diameter 38 mm.3.KN13/39 MEEK cutting axis with 13 ceramic coated circular blades, diameter 39 mm.3.MAC02 MEEK sterilization case 434x254x172 mm3.MAC03 MEEK sterilization case for cutting axis 180x50x45 mm.3.RM004 MEEK pneumatic block motor with connectors and coupling3.087 MEEK cylindrical pneumatic motor with connectors and coupling3.SHD MEEK hand drive set3.SW01 MEEK serrated wedge (cam)Disposables2.3/10 MEEK Micrograft gauze, expansion 1:3, with cork plate, box 10 pcs.2.4/10 MEEK Micrograft gauze, expansion 1:4, with cork plate, box 10 pcs.2.6/10 MEEK Micrograft gauze, expansion 1:6, with cork plate, box 10 pcs.2.9/10 MEEK Micrograft gauze, expansion 1:9, with cork plate, box 10 pcs.2.3/40 MEEK Micrograft gauze, expansion 1:3, with cork plate, box 40 pcs.2.4/40 MEEK Micrograft gauze, expansion 1:4, with cork plate, box 40 pcs.2.6/40 MEEK Micrograft gauze, expansion 1:6, with cork plate, box 40 pcs.2.9/40 MEEK Micrograft gauze, expansion 1:9, with cork plate, box 40 pcs.2.9190 Leukospray ® adhesive, bottle 200 ml.2.JG598 STERILIT ® oil for surgical instruments, bottle 50 ml.

V Supplier20Humeca BVP.O. Box 40175 Het Bijvank 251-a7504 RD Enschede 7544 DB EnschedeThe NetherlandsThe NetherlandsPhone: +31 53 4762619Fax: +31 53 4771905E-mail: info@humeca.nlWeb: www.humeca.nlHumeca is an EN-ISO 13485:2003 certified company

21MEEK MicrograftingPicturescylindrical motor and hand drive

22Fig. 1 MEEK cutting machine, main partsFig. 2 Blades axis with the bearings in their seats and the coupling to the left side

23Fig. 3 Motor and sterile casingFig. 4 Placing motor in casingFig. 5 Motor in correct position in casingFig. 6 Placing motor on the machineFig. 7 Correct position of motor casingFig. 8 Closing motor clampFig. 9 Motor in position on the machineFig. 10 The foot pedal

24Fig. 11 Connecting the hose to the motorFig. 12 Hose correctly connectedFig. 13 Connecting hose to the foot pedalFig. 14 Instruction for fixing the quick connector to the air supply hose

25Fig. 15 Placing the hand drive (1) Fig. 16 Placing the hand drive (2)Fig. 17 Final position of the hand driveFig. 18 Underside of the cutting blockFig. 19 Holes for applying oil

26Fig. 20 and 20A Sterilization case 3.MAC02(Either the yellow cylindrical motor housing, or the block-shaped motorhousing is used. In this drawing both are shown)

27Fig. 21 Prefolded gauze and cork plateFig. 22 Cork plateFig. 23 Cork plate covered with graftFig. 24 Small graft pieces can be usedFig. 25 Cutting block with cover openFig. 26 Cutting block with cover closed

28Fig. 27 Always move the cutting block from the side of the hand wheel to theother side; never the other way round !!Fig. 28 The cam is placed on thecutting block to prevent sticking of thegraft to the cover at openingFig. 29 First lift the cover a little, whilepressing the cam down……

29Fig. 30 ….. then open the coverFig. 31 The double cutting blockFig. 32 The graft is cut into 196 squaresFig. 33 The central pleated area of a gauzeFig. 34 The graft, fixed tothe gauze after removal ofthe cork plate

30Fig. 35 The gauze with grafts after extension in one directionFig. 36 The gauze with grafts after extension in both directions

31Fig. 37 The extended gauze with graft islands isfixed to the wound with staples.Fig. 38 MEEK gauzes on a wound adjacent to each other.

32Fig. 39 A gauze with grafts is cut into smaller piecesto graft smaller areas.Fig. 40 Gauzes are being removed on the 6 th day post-grafting

Fig. 41 Result of burn treatment by MEEK technique on the back ofa patient shortly after complete epithelialization33