Frugal Skin Graft Expansion Device

Burns are a common and significant public health problem in developing countries globally, including several countries in Africa. Over a million people suffer from burn injuries each year in Africa, accounting for over 18% of hospital admissions and leading to mortality rates close to 10%. Despite the prevalence of burn injuries, less than 5% of the typical national healthcare budget is allocated to the treatment of burn victims, a statistic that is exacerbated by the high costs of burn treatment in developing countries, which is approximately twice the costs in the United States. The high cost of burn treatment in the developing world stems from the lack of affordable and effective methods and devices to mesh skin grafts, a procedure used to expand the donor graft surface area and cover more burn area, that are optimized for use in low resource settings. Current skin meshers are not only price prohibitive, but also complicated and time-consuming to use, maintain, and sterilize for reuse. With the goal of developing frugal tools and technologies that meet the needs of health practitioners in developing countries, we gained input from users in both low- and high-resource settings to design an affordable, modular, and autoclavable skin meshing device. Unlike traditional skin meshers that require the grafts to be continuously fed into a blade and roller mechanism, our design emulates the function and form of pie crust cutters to make small slits in a regular lattice pattern while the graft remains fixated on a cutting surface. The design is composed of three main subsystems: (i) handle/stabilization bar, (ii) cartridge that houses the blades to make the slits and (iii) graft fixation mechanism that holds the skin taut during meshing. These parts can be disassembled for cleaning and autoclave sterilization, and easily reassembled for reuse. Our proof-of-concept studies using skin substitutes as well as animal skin grafts demonstrated the ability of the prototype device to create a standard mesh pattern and thereby facilitate expansion of the test grafts. Furthermore, the modular design enables different meshing ratios by simply changing the inter-blade distance. Collectively, our proposed device is a more frugal and user-friendly alternative to current commercial skin meshers and has the potential to improve the overall success and quality of treatment of burn patients in traditionally underserved communities.