Biomedical Engineering Reference
In-Depth Information
taken from a suicide victim, to treat a patient with a severe burn from a lightning
injury and reported an immediate take of 75%. German surgeon Carl Thiersch first
recognized the importance of preparing the recipient bed. In 1874, he described the
removal of granulation tissue from the wound before graft application, which
dramatically improved the success of engraftment (Thiersch, 1874). At the turn of
the 19th century, skin graft use was not widely accepted owing to unreliable
success, difficulty with harvesting and the belief that skin grafting creates two
wounds from one (i.e. the donor site and the wound needing coverage). An
important advancement occurred with the advent of meshing the harvested skin by
Swedish surgeon, Otto Lanz, enabling the combined grafting of the donor site and
the wound (Paletta
et al
., 2006). However, it was not until Saint Louis plastic
surgeon James Barrett Brown and oral surgeon Vilray Papin Blair described their
skin graft techniques did reproducible results from skin grafting gain wide
acceptance. Brown and Blair distinguished between full-thickness, intermediate-
thickness and epidermal grafts and, importantly, they showed the reliable healing
of donor sites if a portion of the dermis was removed, a common misconception
(Blair and Brown, 1929; Brown and McDowell, 1949).
Once the principles of successful skin grafting were disseminated, the primary
challenge of skin grafting was the harvest. The first device designed for skin
harvesting was developed by Humby in 1936. Prior to this grafts were generally
harvested with a razor or long blade in a freehand fashion producing grafts of
variable thickness. The Humby knife is a guarded razor which prevented surgeons
from harvesting grafts too thick; however, it still did not allow for fine control of
graft thickness (McDowell, 1977). During the era of World War II when the
demand for a quick and consistent method was required by the army, Earl Padgett,
an American surgeon from Kansas, in collaboration with an engineer named
George Hood, developed the first dermatome to allow skin graft harvest of precise
thickness in 1939 (Padgett, 1939).
The history of skin graft use is intimately associated with the treatment of burn
injury. The first reported use of skin grafts to cover burn wounds was introduced
by Pollock in 1871. He courageously donated small portions of his own skin in
combination with the burn victim's skin to cover a large burn, establishing one of
the most important modern functions of skin grafts (Freshwater and Krizek, 1978;
Pollock, 1871). The use of skin grafts has revolutionized the care and, importantly,
the morbidity and mortality of burn patients. World War II provided impetus for
the use of refrigerated skin as a temporary dressing (Webster, 1944), the founda-
tion of the first skin bank in the United States (Trier and Sell, 1968) and the
discovery of a cryo-preservative agent that permitted freezing of tissue and
subsequent thawing in a viable state (Polge
et al
., 1949).
5.3.2 Principles and techniques of autologous skin grafts
Autologous skin grafts are broadly categorized based on their thickness as full or
