A multicenter randomized controlled trial assessing and comparing long-term scar quality after micrografting versus mesh grafting of deep dermal burns

Patients with deep dermal/subdermal (burn) wounds often have an indication for a skin transplantiation. Most common method is split skin grafting (SSG). Surface area of the skin graft is mostly expanded to retain a small donorsite (wound after harvesting of the skin graft). Skin graft expansion is generally performed by the meshed skin grafting technique, seen this method is considered to be quick and easily applicable. Yet, this technique also has several limiations. For the surgeon this method becomes more cumbersome when the expansion ratio increases. Moreover, the actual expansion of the skin graft is usually lower then the intended expansion ratio and the "fish-net" pattern often stays visible in the eventual scar. An alternative for skin graft expansion is the micrografting technique (Meek technique). In comparision with meshed skin grafting this technique is able to reach large expansion ratio's and thereby maintain small donorsites. As a consequence, this technique is used in particular for very extended (burn) wounds. Both expansion methods are used worldwide in specialized burn centers. Wound healing seams to be similar according to previous published literature. Experience shows an possible advantage of micrografting on scar quality. Three studies compared these two expansion techniques, however none primarily investigated possible differences within long-term scar quality. Given the increasingly prominent role of scar quality in (burn) wound care, a randomized intra-patient controlled trial to compare long-term scar quality of both skin grafting techniques is highly preferred.

Our hypothesis is that treatment with micrografting, when compared to conventional meshed graft, will result in a better scar quality and smaller donor site size.

During admission, 3 months and 12 months after operation

Prior to surgery two comparable (burn) wounds or two equal parts in one (burn) with a minimum size of 36 cm2 will be selected. These wounds will be randomly allocated to the intervention method (micrografting) or the comparison method (meshed skin grafting).