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Global Health Technologies

Undergraduate Lightning Talks

Low-Cost Template for Rapid and Accurate Meshing of Autograft Skin in Surgical Burn Care

Saturday, October 26, 2024
1:40 PM - 1:45 PM EST
Location: Room 342

Introduction:  Sub-Saharan Africa (SSA) accounts for 21% of global annual burn deaths despite comprising only 15% of the world's population. Skin grafting, essential for treating severe burns, often requires meshing to expand graft coverage. However, commercial skin meshers are scarce in SSA due to high costs, ranging from 600 to 7,500 USD.

We propose a novel, low-cost template design to guide hand-meshing of autograft skin, potentially transforming burn care in resource-limited settings. The template consists of two parallel plates with alternating extrusions, creating a specific incision pattern when skin is compressed between them.

Preliminary tests using tattoo practice skin demonstrate significant improvements over traditional hand-meshing. The template reduces meshing time from over 5 minutes to under 1 minute for a 10 cm x 10 cm graft, achieving expansion ratios up to 1.70:1, surpassing the typical 1.50:1 ratio of hand-meshing.

This innovation offers a more accessible alternative to commercial skin meshers, addressing limitations of both hand-meshing and machine meshers. By improving speed, consistency, and degree of skin graft expansion, our template could significantly enhance surgical burn care outcomes in SSA and other low-resource settings.

Future research will focus on developing templates capable of achieving even higher expansion ratios, using cadaver skin for tests, and maintaining or reducing meshing time.

Materials and

Methods:  We developed a novel skin graft meshing template consisting of two interlocking plates. The template was designed to create a uniform pattern of incisions in skin grafts, allowing for expansion. Prototypes were fabricated using laser-cut acrylic and 3D-printed polyethylene terephthalate glycol.
Two designs were tested: a flat template and a plateau template with extrusions to improve skin compression and facilitate smoother scalpel motion. The plateau design featured parallel channels on the top plate for guiding the scalpel.

Testing was conducted using tattoo practice skin as a model for human skin grafts. We compared meshing time between hand-meshing and template-assisted meshing. The consistency of the resulting patterns was quantified by measuring incision dimensions using ImageJ software.
Expansion ratio was calculated by measuring the skin dimensions before and after meshing and stretching. Void area was also measured to assess the effectiveness of the meshing pattern.

Statistical analysis was performed using one-way ANOVA and Tukey's range test to compare meshing times and incision dimensions across different template designs and etch depths.

The plateau template's performance was evaluated based on its ability to achieve the target expansion ratio of 2.00:1 and create void areas within acceptable limits. Five replicates were tested to assess consistency and reliability of the meshing process.

Results, Conclusions, and Discussions: The plateau template demonstrated improvements over traditional hand-meshing techniques. Meshing time decreased dramatically from 262 ± 12 seconds for hand-meshing to just 43 ± 1 seconds with the plateau template, representing a six-fold increase in efficiency. The plateau design successfully achieved an average expansion ratio of 1.70, closely approaching the desired 2.00:1 ratio and significantly outperforming hand-meshing capabilities.

Our innovative plateau template design represents a breakthrough in burn care for resource-limited settings. By drastically reducing meshing time and achieving expansion ratios previously unattainable through hand-meshing, this tool has the potential to revolutionize treatment for burn victims in sub-Saharan Africa and beyond.

This project addresses a critical global health challenge by providing a cost-effective, efficient solution for skin graft meshing in regions where commercial meshers are unavailable. The plateau template's ability to significantly reduce operation time could lead to improved patient outcomes and increased surgical capacity in overwhelmed burn units. The successful achievement of higher expansion ratios means that larger burn areas can be treated with limited donor skin, a crucial advantage in severe burn cases. This innovation has the potential to save countless lives and reduce the burden of burn injuries in low-resource settings. Future refinements and clinical trials could further enhance the template's performance, potentially making it a standard tool in global burn care. This project exemplifies how targeted technological innovations can address pressing global health needs and improve healthcare equity worldwide.

Acknowledgements (Optional):  This device was developed with the support of the Johns Hopkins University Department of Biomedical Engineering’s undergraduate design team program. The authors would like to thank Dr. Jess Dunleavey for providing access to a designated lab space for tissue dissection, and Tom Benassi for prototyping advice. They are also thankful for the guidance of Arushi Biswas, Dr. Pedro Santos, Dr. Erica Hodgman, and Dr. Cameron Gibson in designing the template.