Successful Meek skin grafting combined with a synthetic dermal matrix in a patient with epidermolysis bullosa.

OBJECTIVE: Epidermolysis bullosa (EB) is a group of skin disorders leading to blister formation and impaired wound healing. Here we present the case of a patient with EB who underwent successful full-thickness Meek skin grafting for the reconstruction of a wide local excision of a cutaneous squamous cell carcinoma. The modified Meek technique is a method of cutting and separating squares of skin graft to obtain a greater expansion ratio than traditional meshed skin grafts.

METHOD: A dermal substitute was used to close the wound in stages, to allow histological clearance before definitive wound closure. The expansion ratio obtained using the modified Meek technique allowed a relatively small donor site skin graft to be used.

RESULTS: The use of a full-thickness skin graft (FTSG) avoided the need for wound closure by re-epithelialisation. This allowed graft donor site morbidity to be minimised.

CONCLUSION: We believe this is the first documented use of the Meek technique in patients with EB, as well as the first use of the Meek technique in conjunction with a FTSG. The combination of a dermal substitute along with the full-thickness Meek skin grafting technique allowed successful and stable reconstruction of a large wound with a minimal donor site, avoiding amputation in this patient. This case demonstrates the potential of this method in this subgroup of patients with impaired wound healing and often limited suitable donor sites.