Abstract: BACKGROUND: Postoperative results with Meek skin grafting in some patients with extremely severe burns have not been satisfactory, with problems of delayed healing or skin graft failure. There have been fewer studies on the treatment of patients with failed Meek skin grafting due to insufficient skin source. This study aimed to explore a treatment method for such patients.
OBJECTIVE: To observe the curative effect of stamp-shaped skin allograft in the treatment of severe burns after Meek skin graft failure. 
METHODS: Twenty-three patients with extremely severe burns who were admitted at Department of Burns and Skin Surgery, the First Affiliated Hospital of the Air Force Medical University from August 2013 to August 2023 with poor healing after Meek skin grafting were enrolled and divided into allogeneic skin treatment group and dressing change group according to different treatment methods. There were 10 cases in the allograft group and 13 cases in the dressing change group. Preoperative hemoglobin, platelet count, albumin count, white blood cell count, neutrophil count, procalcitonin count, and positive rate of microbial culture before secondary Meek skin grafting were compared between two groups. Survival rate of skin grafts before and after the second operation were compared. The number of operations, incidence of sepsis, and wound scars at 3 months and 6 months after operation were retrospectively analyzed. 
RESULTS AND CONCLUSION: The preoperative hemoglobin, platelet count and albumin count in the allogeneic skin treatment group were significantly higher than those in the dressing change group (Z=-3.172, P=0.002; Z=-3.010, P=0.003; Z=-2.761, P=0.006). There was no significant difference in the preoperative white blood cell count and neutrophil count between the two groups before secondary Meek skin grafting (Z=1.148, P=0.251; Z=0.373, P=0.709), but the serum procalcitonin count in the allogeneic skin treatment group prior to the second operation was significantly lower than that in the dressing change group (Z=2.955, P=0.002). Burn patients in the dressing change group exhibited a higher microbial culture rate than those in the allogeneic skin treatment group (χ²=6.303, P=0.029). The survival rate of skin grafts before the second operation in the allogeneic skin treatment group [(74.8±13.3)%] was significantly higher than that in the dressing change group [(58.4±14.2)%; t=2.85, P=0.01). The survival rate of skin grafts after the second stage operation in the allogeneic skin treatment group [(84.0±11.5)%] was significantly higher than that in the dressing change group [(67.6±20.7)%; t=2.24, P=0.03). The frequency of postoperative surgery in the allogeneic skin treatment group was less than that in the dressing change group (Z=2.27, P=0.02). The incidence of sepsis in the dressing change group was significantly higher than that in the allogeneic skin treatment group (χ²=5.490, P=0.03). There was no significant difference in the Vancouver Scar Scale scores of the scars between the two groups at 3 and 6 months after operation (t=0.96, 1.138, P > 0.05). To conclude, stamp-shaped skin allograft has good curative effect in the treatment of wounds with poor healing of skin after Meek micro-transplantation. The utilization rate of skin in the later stage is significantly increased, which reduces the probability of wound infection and solves the problem of insufficient skin source. 

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: extremely severe burn, extensive burn, stamp-shaped skin allograft, Meek skin graft, delayed healing