The true meshing ratio of skin graft meshers

Skin meshing is frequently used in the coverage of extensive burn injuries as well as other skin and soft tissue wounds. This technique allows coverage of more extensive areas with smaller donor sites and prevents fluid from collecting beneath the skin grafts. The devices used to achieve this expansion differ in their technology and the use of skin carriers. In addition, many of the devices permit meshing at single or multiple ratios depending upon the device chosen. Although commonly used, there have been few definitive studies analyzing the actual expansion ratios achieved by many of these devices. The purpose of this study was to measure the actual meshing ratios achieved using some of the most commonly used skin meshers. The authors used split-thickness cadaveric skin samples provided by the regional tissue bank to compare the area of skin both before and after meshing to determine the actual expansion ratio and compared that with the ratio claimed by the device manufacturer. For all ratios greater than 1:1, the extent of actual expansion was significantly less than that expected for each device (P < .001). In addition, using devices that claimed to yield increasingly greater expansion ratios resulted in increasingly greater discrepancies between the area predicted by the device manufacturer and the actual surface area of skin (P < .01). These findings suggest that there is great variability in the expected and observed expansion ratios achieved by skin graft meshing devices. This has significant applicability to practice as it is likely to affect surgical decisions related to estimating the extent of donor area needed to cover skin and soft tissue defects.