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.