Meek Case 2

by Prof. Ognian Hadjiiski, MD, Pirogov Emergency Medical Institute, Sofia, Bulgaria.

The patient, a 16 year old male who sustained a 65% TBSA flame burn in the back, chest, arm and legs, was brought into our center 14 hours after the accident. He was in thermal shock and had inhaled smoke. On day 3, 5 and 7 we performed early surgical excision of the necrotic tissue in the legs, chest and belly in 32% TBSA, leaving 14% disseminated necrotic tissues. The wound surfaces were covered with micrografts in five surgical steps every third to fifth day. The total donor site area was 14%. The donor sites were large because of the need to change some of the marks in subsequent surgical stages. During treatment the patient developed generalized bacterial infection, which was appropriately treated. On day 79 he was discharged in good health.

The area of the skin autografts performed in one operation was less than 2% TBSA and the blood loss from the donor sites was no more than 300-400 ml. In the third operation on a separate site we left the gauze until day 7-9. We do this only when the grafting is good and there is no local infection or exudation. After removing the gauze we observe initial epithelialization between the marks. It is important to bear in mind that in certain conditions removal of the gauze can be postponed. The advantage is that the sterile milieu is left undisturbed, some of the marks remain stable and allograft is not necessarily used to cover the wound surface.

Discussion

In extensive burns (more than 30% TBSA), whole autografts can be used only in 18% of surgically treated patients and donor sites are limited. If donor sites are used, the treatment last for several months, with numerous operations – a period in which the patient might develop a severe catabolic syndrome, organ insufficiency and generalized infection, which may be fatal. We believe, like many other researchers, that the MEEK technique shows significant positive results with respect to conventional techniques. The MEEK technique equalizes the distribution exactly to which was planned, whereas with the meshgraft technique the expansion is smaller (20-45%). The MEEK technique combined with allografts ensures better results, especially if removal of the necrotic tissues is performed early. This technique obviates the application of tissue cultures.

Conclusion

The MEEK method is suitable in the treatment of burns, especially in large area burns. Its application saves the lives of patients in case other operative methods do not have positive results. The method is also recommended when other methods are impossible (tissue cultures). The late results of the MEEK method are very good.

See also CASE 1 and CASE 3