Biomedical Engineering Reference
In-Depth Information
understanding skin grafting. The skin forms a continuous protective layer over the
entire surface of the body. The character of skin is variable between individuals
and between different body regions of the same individual based on age and sun
exposure. During the first decade of life, skin is thin but progressively thickens
until the middle of the fourth decade. By middle age, the dermis undergoes gradual
thinning and a decrease in elasticity and sebaceous gland content. Within the same
individual, skin varies by body region. The skin of the eyelid, post-auricular and
supraclavicular areas, and medial thigh is thin in comparison to the much thicker
skin of the back, palms of the hands and soles of the feet.
5.3
Autologous skin grafts
5.3.1
History of skin grafts
The history of skin transplantation mirrors the evolution in the understanding of skin
anatomy, physiology, the biology of wound healing and the immunology of
transplant rejection. The earliest reports of skin grafting date to the 3rd century BC;
the
Sushruta Samhita
sanskrit texts document skin transplantation in ancient India.
Ancient texts describe Koomas caste members (the potter and tile-making guild)
performing nasal reconstruction after mutilation as punishment for crimes (Bhisha-
gratna, 1963). Subsequent reports of skin transplantation did not emerge until the
15th century. Brancas, and later Tagliacozzi, report the utilization of skin grafts for
nasal reconstruction of facial battle wounds and tissue infection caused by syphilis.
A seminal work by Tagilacozzi in 1597 in
De curtorum chirugia per isitionem
,
established his role as the pioneer of modern plastic surgery (Herman, 2002).
Prior to the 1800s reports of skin grafting in Western medicine were anecdotal
and not widely accepted. The Italian Guiseppe Baronio famously described
successful autograft transplantation of sheep skin in 1804. Notably, Baronio's
experiments with transferring skin from a mare to a cow failed - hinting at the
immunologic barriers in xeno-transplantation to be elucidated in the future (Davis,
1941). In 1817, British surgeon Astley Cooper successfully removed skin from an
amputated thumb and covered the base of the remaining stump with the full
thickness skin graft. In 1823, Bunger revived ancient Indian methods of nasal
reconstruction by repairing nasal defects with full-thickness skin grafts (Patterson,
1977, Chick, 1988). Swiss surgeon Jacques Reverdin is credited with performing
the first epidermal allograft ('pinch grafts') and the first split-thickness skin graft,
in 1869. His work demonstrated that skin transfer from a donor site to an open
wound in the same individual not only survived but hastened healing. Two years
later, Ollier furthered Reverdin's work by demonstrating a better skin graft
outcome with faster wound healing and less scarring by using grafts composed of
epidermis and dermis (Ollier, 1872).
As an extension of Reverdin's work, Girdner published the first report of skin
grafting using human cadaveric skin (Girdner, 1881). He employed allograft skin,
