Andrea Noy

Background: Severe burn wounds accounted for nearly 13 million cases globally in 2021, and their prevalence is projected to increase. Recovery from such wounds is a multi-faceted and strenuous journey, requiring surgical intervention, skin grafting, physical therapy, and psychological rehabilitation. As such, the functionality and aesthetics following a burn scar, as well as the time to heal, are critical metrics for restored mobility and quality of life. Such metrics are the consequence of burn wound grafting, where the current standard is to use allografts as a temporary cover until sufficient autograft can be harvested and expanded using the Meek micrografting technique. Unfortunately, this process is time-consuming and labor-intensive, prompting the need to evaluate alternative reconstruction materials and techniques. Alternative ways to synthesize autografts and allografts include arranging them in alternating patches and layering autografts with bioengineered allografts such as acellular dermal matrices and absorbable biomaterials. The success of such alternatives would better streamline the wound healing process without sacrificing the resulting scar quality.

Methods: PubMed was the primary data source, and search terms included “burn wounds”, “autograft”, “allograft”, and “skin substitutes”.

Results: The first study compared an alternating arrangement of allografts and autografts against Meek and microskin techniques. It found that the time to heal was significantly higher in the mixed method, but that there was no significant difference in scar pliability, vascularity, pigmentation, and height between the mixed method and Meek. These metrics were also lower in the mixed group than for Microskin. The second study compared a thick STSG against covering a thin STSG with an acellular dermal allograft. There was no significant difference between the two for healing time, scar vascularity, pigmentation, height, and hand function, though the thick STSG had greater scar pliability. Finally, the third study layered an absorbable Meek material over an autograft and compared against pure autograft in pigs, finding no significant difference after one month of healing.

Conclusions: The wound healing process has many points for optimization that still enable similar outcomes. Specifically, skin substitutes such as the acellular dermal allograft can reduce the burden of autografts for a patient while still enabling similar scar quality. Additionally, combining allografts and autografts such that they can be applied simultaneously and using absorbable Meek material coverings reduce the time and labor required during graft and bandage exchanges. Thus, further advancement is required not only for novel techniques to integrate autografts and allografts, but also for bioengineering skin substitutes.

Works Cited:

1. Cleveland Clinic. Types of burns & burn pain treatment. Cleveland Clinic. Published August 24, 2020. https://my.clevelandclinic.org/health/diseases/12063-burns
2. Integra® Dermal Regeneration Template. Integralife.com. Published 2024. https://products.integralife.com/integra-dermal-regeneration-template/product/wound-reconstruction-care-inpatient-acute-or-integra-dermal-regeneration-template
3. Ng JC, Ahmad Zaidi AI, Lee J, Jabar MF. Meek Micrografting Technique for Reconstruction of Extensive Necrotizing Fasciitis of the Anterior Abdomen and Bilateral Femoral Region: A Case Report. Arch Plast Surg. 2023;50(6):610-614. Published 2023 Aug 24. doi:10.1055/a-2077-5745
4. Yu H, Jafari M, Mujahid A, et al. Expansion limits of meshed split-thickness skin grafts. Acta Biomater. 2025;191:325-335. doi:10.1016/j.actbio.2024.11.038
5. Ji C, Wang Y, Chen T, et al. Mixed grafting of small auto- and cryopreserved allo-skin for residual wound repair in severe burn patients: A retrospective study. Burns. 2025;51(2):107356. doi:10.1016/j.burns.2024.107356
6. Gierek M, Łabuś W, Kitala D, et al. Human Acellular Dermal Matrix in Reconstructive Surgery-A Review. Biomedicines. 2022;10(11):2870. Published 2022 Nov 9. doi:10.3390/biomedicines10112870
7. Li F, Zhang JY, Guo YL, Zhang W. Absorbable Meek skin graft material transplantation: A preliminary experimental study. Burns. 2025;51(3):107387. doi:10.1016/j.burns.2025.107387
8. Sierra-Sánchez Á, Magne B, Savard E, et al. In vitro comparison of human plasma-based and self-assembled tissue-engineered skin substitutes: two different manufacturing processes for the treatment of deep and difficult to heal injuries. Burns Trauma. 2023;11:tkad043. Published 2023 Oct 30. doi:10.1093/burnst/tkad043
9. Chogan F, Chen Y, Wood F, Jeschke MG. Skin Tissue Engineering Advances in Burns: A Brief Introduction to the Past, the Present, and the Future Potential. Journal of Burn Care & Research. 2022;44(Supplement_1):S1-S4. doi:https://doi.org/10.1093/jbcr/irac127
10. Ling XW, Jiang X, Guo HL, Zhang TT. Deep burn surgery of the whole dorsum of the hand: Composite skin grafting over acellular dermal matrix versus thick split-thickness skin grafting. Int Wound J. 2024;21(5):e14934. doi:10.1111/iwj.14934
11. Lee N, Bae Y, Jang S, Lee DW, Lee SW. Global, Regional, and National Burden of Burn Injury by Total Body Surface Area (TBSA) Involvement from 1990 to 2021, with Projections of Prevalence to 2050. Healthcare (Basel). 2025;13(16):2077. Published 2025 Aug 21. doi:10.3390/healthcare13162077