Clinical experience with postage stamp autograft using additional cadaveric skin and porcine skin overlay in extensive burns

Six patients with extensive burns (>40% TBSA) were treated with a postage stamp Autograft using either meshed porcine skin or cadaveric skin overlay during the period from November 1992 till August 1993. The scalp was one of the ideal donor sites. When the skin grafts were harvested and cut into 1 cm postage stamp square sizes. These squares were applied to the recipient site with a distance of 1.5 to 2.0 cm, then overlaid with meshed porcine skin or cadaveric skin. The expansion ratio could reach from 1:6 to 1:9. On an average the first operation was 4.8 days after the initial injury. Most cases had a smooth course with few post-operative complications except for two cases of debridement-induced bacteremia, which was able to be well controlled by antibiotic therapy. The successful graft rate was nearly 100% in five patients, but one patient had a 40% grafted skin lost because of inadequate dressing and wound infection. The average grafted area was 28.3% TBSA. The epithelialized circles of the grafted postage stamp squares were mostly confluent with each other, but further skin grafting was needed in an average of about 4.2% TBSA. The average slough-off time of biologic dressing was 9 days post-operative in the porcine skin group and 12 days in the cadaveric skin group. During the operating procedure it was found that porcine skin coverage was easier than cadaveric skin from a technique point of view. Wound-healing time and appearance showed no significant differences in the two groups.