Meshed split thickness skin graft: how it works and when it is used

What is a meshed split skin graft?

A split thickness skin graft (STSG) is harvested with a dermatome as a thin layer that includes the epidermis and part of the dermis, leaving the deeper dermal appendages at the donor site to heal. Compared with a full-thickness graft, a split graft takes more reliably on difficult wound beds and the donor site can re-epithelialise.

Meshing means making a regular pattern of slits in the harvested graft with a mesher. When the graft is stretched, the slits open into a net. The result is a mesh skin graft that covers a larger area than the piece that was taken; the gaps heal by epithelialisation from the edges. So, is mesh considered a graft? Yes: it is still a split-thickness autograft, and the mesh describes how it is prepared.

Mesh ratios and what they mean

The mesh ratio indicates how far a graft can be expanded. Ratios in clinical use range from about 1:1.5 up to about 1:9, depending on the device and technique; the common ratios are lower than the extremes. A higher ratio covers more area but leaves larger open spaces and typically heals more slowly with a more pronounced mesh pattern.

The ratio is chosen by the surgeon based on wound size, donor availability and location. A mesh protocol therefore varies between centres. Equipment buyers should check which ratios the device supports, how they are achieved through carriers or cutters, and what replacement carriers cost; see carriers for skin graft meshers.

When burn and plastic surgeons choose meshed grafts

Meshed grafts are mostly used when the wound is large relative to the available donor skin, as in extensive burns, and on areas where fluid could collect beneath the graft since the slits allow drainage. Sheet grafts are often preferred when appearance is important, for example on the face and hands, although the decision depends on the case.

The trade-offs between the two techniques are discussed in sheet graft versus mesh graft. The types of skin graft available, including split, full-thickness and others, are outlined in standard surgical references; this article concentrates on the meshed type and the equipment.

Equipment used to prepare a meshed graft

Harvest uses a dermatome. NOUVAG's TCM 3000 BL motor system drives the NOUVAG Dermatome, with cutting widths of 75 or 100 mm, a cutting depth adjustable from 0.05 to 1.0 mm and tool-free blade change. See electric dermatomes.

The NOUVAG Mesher is a skin expansion system: the harvested graft is placed on a carrier plate and perforated in a regular pattern, which lets it be widened to cover larger wounds and reduces the need for additional donor harvesting. Its knife roller is removable for maintenance and cleaning. For the steps, see how to use a skin graft mesher.

• Dermatome for harvest, depth adjustable 0.05 to 1.0 mm
• Mesher with carrier plate for expansion
• Removable knife roller for cleaning
• Dressings and fixation chosen by the surgeon

Planning equipment for your unit

Burn centres should plan for dermatome, mesher, spare carriers, sterilisation trays and training together. A single supplier simplifies service. Verify device registration in the UAE and ask about spare parts and loan units.

Beckfinity distributes NOUVAG in the UAE. Discover the Mesher or contact our specialists to plan a configuration.