‘‘Flypaper technique’’ a modified expansion method for preparation of postage stamp autografts Su-Shin Lee a,c, * , Tsai-Ming Lin a,c , Yi-Hui Chen b,d , Sin-Daw Lin a,c , Chung-Sheng Lai a,c a Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan b Shin-Sheng Clinics, Ping-Tung, Taiwan c Plastic Surgical Association, Taiwan d Formosan Medical Association, Taipai, Taiwan Abstract The gold standard for management of extensive burn has been early excision, temporary allografting and final autografting. However, ‘‘lack of donor skin’’ is a challenge condition when autografting in the treatment of extensive burns. Designing an efficient and easy to apply expansion method may improve burn care quality and shorten the hospital stay period. From December 1998 to May 2004, we have performed fly paper technique postage stamp skin autografting for eight major burn patients in the Kaohsiung Medical University Hospital. By using a quick cutting plate, chessboard tray and petrolatum gauze, the skin islands can be uniformly located and correctly oriented on gauze. Then, the gauze with skin islands was grafted on to the wound. The wound healing time depends on the size of skin islands and expansion ratio. This method allows true expansion ratio up to nine times. The average wound healing times are 27.2 days for six times expansion and 34 days for nine times expansion. However, the burn scar needs further compression therapy to improve the cosmetic result. In comparison with the mesh technique, the skin islands are independent of each other, any dislodgement of a skin island will not interfere with the surrounding skin squares. When compared with the modified Meek technique, this method also offers rapid wound reepithilization but with lower cost. This flypaper technique is worthy of consideration in dealing with the extensive burns. # 2005 Elsevier Ltd and ISBI. All rights reserved. Keywords: Modified Meek technique; Micrografting; Postage stamp autograft 1. Introduction The gold standard for management of extensive burns has been early excision, temporary allografting and final autografting [1]. However, early and permanent coverage of extensive burn wounds is difficult because of the shortage of donor sites. Designing an efficient and easy to apply expansion method may improve the burn care quality and shorten the hospital stay period. To overcome this problem various methods of skin grafting have been reported in the past, such as the conventional postage skin graft [2], mesh grafting [3], intermingled transplantation of auto and homografts [1], microskin grafting [4] and the Meek technique [5]. In 1993, Kreis et al. [6] reported a modified Meek technique. The true nine times expansion rate and the early confluence of the skin grafts have popularized the modified Meek technique in the treatment of extensive burn patients. However, the relatively high cost of this technique prevents it from been used widely. In 2000, Lee et al. [7] reported a modified postage stamp autografting technique to achieve regular distribution of these skin squares and effectively shortening the wound healing time. In this series, we report the ‘‘fly paper technique’’ which was orientated from the modified postage stamp autografting method. By simplifying the preparation procedure, the result of postage stamp autografting improved and the operation time shortened. The experience of the fly paper technique is presented. www.elsevier.com/locate/burns Burns 31 (2005) 753–757 * Corresponding author. Tel.: +886 7 3208176; fax: +886 7 3111482. E-mail address: sushin@kmu.edu.tw (S.-S. Lee). 0305-4179/$30.00 # 2005 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2005.04.001