MEEK surgery

Double pleated gauze with cork plate	Cutting  machine	Graft cut into squares

At operation wounds to be grafted are excised down to the underlying fascia and haemostasis is secured. A square piece of cork measuring 42x42 mm with thickness 2 mm is covered with a split skin autograft, dermal side down. Smaller graft remnants are also suitable by placing them on the cork plate like a "puzzle". The cork, covered with graft, is then placed in a cutting machine.

The machine contains 13 parallel circular blades. The cork plate with the graft on it, is passed through the dermatome, where the blades cut through the graft, but not through the cork. Thus the graft is cut into 14 stripes 3 mm wide. After the first pass, the cork is rotated 90° and passed through the dermatome for the second time, thus cutting the graft into 14x14 pieces measuring 3x3 mm. Then the cork plate, with the cut graft in place, is removed from the machine.

The upper (epidermal) surface of the graft is sprayed with an adhesive dressing spray and allowed to dry and become tacky. The cork plate, covered with graft and adhesive is then pressed onto a prefolded gauze. This gauze is folded on a backing into 14x14 square pleats that correspond to the cuts in the autograft. Then the cork is gently removed, leaving the graft islands adhering to the gauze. The gauze is pulled out by firm traction on all four sides, until the pleats become completely unfolded. Finally the backing is peeled off, to leave the expanded gauze with the separated adherent autograft islands ready for transplantation. 

Cork plate pressed to the plissee	Plissee extracted in the first direction	Plissee completely unfolded

After trimming the margins, the gauze is applied, graft side down, to the wound bed and secured with surgical staples. After about 6 days the grafts have grown sufficiently into the wound bed to allow removal of the gauze, leaving the autograft islands in situ on the wound. Daily dressings are continued until epithelialization is complete. 

Gauzes are applied to the wound	Details of gauzes on the wound	Gauzes are removed from the wound

You can watch a film showing MEEK surgery here:

Instructions for use of the Meek procedure are enclosed in a manual. You can download it from the section downloads (bottom of the page).