To investigate the clinical efficacy of the modified plantar skin harvesting technique in treating patients with extensive deep burns.

A retrospective analysis was conducted on 65 patients with extensive deep burn wounds admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of the Joint Service Support Unit of PLA between January 2018 and August 2024，including 45 males and 20 females，aged 18–80 （41.83±0.22） years. The total burn area ranged from 30% to 97% TBSA，and the full-thickness burn area ranged from 30% to 85% TBSA. Skin harvesting from both soles was performed 1 to 4 （1.8±0.9） times using either conventional or modified methods. Among them，22 patients who underwent one session of skin harvesting using the conventional method were assigned to the conventional group，21 patients who underwent one session using the modified method were assigned to the single-harvest group，and 22 patients who underwent 2 to 4 sessions using the modified method were assigned to the repeated-harvest group. The modified technique included several measures，such as dekeratinization of the donor site，avoidance of skin harvesting from weight-bearing areas，expanded skin harvesting areas，use of different dermatomes and techniques based on the specific body region，application of wound dressings to the donor site，and postage stamp-style thin split-thickness skin grafting. After the final harvesting session，comparisons were made between the single-harvest group and the conventional group，as well as between the single-harvest group and the repeated-harvest group，in terms of the final skin harvesting area，skin graft survival rate at 7 days，donor site healing time，and Vancouver scar scale （VSS） scores at 6 months postoperation. Additionally，the intervals between two consecutive harvesting sessions were calculated for the 22 patients in the repeated-harvest group. Walking function and donor site complications were observed during a 6-month follow-up.

After the final skin harvesting session among the 65 patients，the harvested areas in the conventional group，single-harvest group and repeated-harvest group were a median of 1.5 （1.0，1.8）%，3.8 （3.0，4.0）% and 3.7 （3.5，4.0） %TBSA respectively. The single-harvest group showed a significantly larger harvested area than the conventional group （U=443.500，P<0.001）. The skin graft survival rates at 7 days for the three groups were a median of 70.0 （65.0，78.5） %，94.0 （91.0，95.0） % and 94.0 （90.0，95.0）% respectively，with the single harvest group being higher than the conventional group （U=448.500，P<0.001）. The donor site healing times for the three groups were a median of 14.0 （13.0，16.0），10.0 （9.0，12.0） and 10.0 （10.0，11.0） days respectively，with the single harvest group being shorter than the conventional group （U=20.500，P<0.001）. The VSS scores of donor sites at 6 months post-operation for the three groups were a median of 4.0 （4.0，5.0），2.0 （2.0，2.0） and 2.0 （2.0，2.0） points，respectively，with the single-harvest group being lower than the conventional group （U=11.500，P<0.001）. No statistically significant differences were observed between the single-harvest group and the repeated-harvest group in any of the above indicators （P>0.05）. The interval between two consecutive skin harvests in 22 patients in the repeated-harvest group ranged from 10 to 45 （12.5±0.5） days. During the 6-month follow-up，all patients exhibited normal gait，and no complications such as pain or ulceration at the donor site were observed.

The modified plantar skin harvesting method can increase the harvested skin area from the soles，improve skin graft survival rate，promote donor site healing，and reduce scarring and complications at the donor site. Repeated harvesting does not affect the therapeutic efficacy，providing an excellent autologous skin source for the repair of extensive deep burn wounds.