Skin graft meshing, over-meshing and cross-meshing

Introduction: Split skin grafts (SSGs) are often meshed to increase their size and allow exudate to escape. We investigated the expansion obtained with meshing, and the possibility of re-meshing skin that has already been meshed ("overmeshing"). Both useful and inadvisable permutations are illustrated. Material and methods: Thin porcine SSGs were sideways meshed, or meshed with ratios of 1.5:1 and 3:1. Subsequently samples were over-meshed in a variety of ratios and directions. All grafts were maximally expanded and their areas calculated. Results:Meshed skin did not expand as much as suggested by the ratios displayed on dermacarriers. A 1:1.5 dermacarrier produced an area expansion of 1.36x, and a 1:3 meshing apparatus produced only a 1.80x area expansion. Several combinations of twice-meshed SSGs maintained integrity as long as over-meshing was done in the axis of initial meshing. Up to 2.3x expansion was obtained, by following a 1:1.5 mesh with a 1:3 mesh. We term this procedure as "overmeshing". Re-meshing in a direction orthogonal to initial meshing (cross meshing) cut the skin into small pieces. Conclusion:Over-meshing a SSG can allow considerable further expansion, facilitating overgrafting of donor sites or simply increasing the area that can be covered with the existing harvested skin. (C) 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.