Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
[Illustration: FIG. 88.—METHOD OF PLACING THIERSCH GRAFTS.]
The graft may be smoothed out with the needle held flatwise or be stroked
down gently, so that its fresh surface makes contact with every portion
of the part covered, a precaution the author considers important to
obtain the best results.
If the defect is large, and where several grafts are needed, the second
flap thus obtained is made to slightly overlap the one already placed,
and so on. The free, or distal, ends of the flaps are made to slightly
overlap the skin or that of a graft placed endwise to it. Every part of
the wound should be covered.
As soon as this has been accomplished the strips are powdered over
with iodol or aristol or protected with some antiseptic gauze (boric
or iodoform), or covered with strips of lint smeared with borated
petrolatum, over which light, teased-out pieces of sterilized cotton are
placed. A gauze bandage may be utilized to hold all in place.
It is quite necessary to have the part kept at rest so as not to displace
the skin-graft arrangement. If the antiseptic powder has been used
the dressings need not be disturbed for a week or ten days, but the
petrolatum dressing must be changed every third day, care being observed
not to disturb the grafts.
Perhaps the best success is obtained by the aid of perforated rubber
tissue, covered with gauze dressing, constantly kept wet with bovinine
for ten days.
In healing, parts of the grafts may die, leaving small areas to
granulate over, but ordinarily the cicatrization resulting therefrom
is indeed slight. From the observations of E. Fisher, it seems that
the most successful results are obtained when the grafts are taken and
transplanted under the bloodless method of Von Esmarch.
_2. Heterodermic Skin-grafting_
=c. Hetero-epidermic Skin-grafting.=—A novel method of covering wounds
with skin is advocated by Z. J. Lusk, of Warsaw, N. Y., 1895, in which
small squares of epithelium, previously prepared, are placed upon the
granulating surface, over which a dressing of sterilized gauze is placed,
saturated with a mixture of balsam of Peru, ʒj, and ol. Ricini, ℥j, and
covered with several layers of sterilized absorbent cotton. The dressing
is allowed to remain undisturbed until the tenth or twelfth day, unless
there is an accumulation of pus.
The advantage of this method is that the epidermal layers can be
collected at random from various patients who present themselves with
blistered surfaces—the result of burns—or where the skin has been raised
by some blistering process for counterirritative reasons.
This loose skin is collected and spread upon a glass plate and sterilized
in warm boric-acid solution, then allowed to dry in this position to
prevent curling, and, when dry, cut into desirable sizes and laid away
for future use.
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