Plastic and cosmetic surgery

by Frederick Strange Kolle

The grafts for this purpose may be taken from freshly killed animals, such as dogs, rabbits, frogs, kittens, etc.

The best results, in the estimation of the author, are obtained by the use of the skin taken from the abdominal region of dogs.

The method for preparing these grafts is to kill a healthy animal, thoroughly cleansing the skin of the abdomen, as already described in the taking of any graft.

The entire abdominal surface is neatly shaved under antiseptic precautions and the skin is dissected off in one piece, leaving the subcutaneous tissue. It is then placed in a warm boric-acid solution and cut into small pieces, say one or two inches square, according to the size of the defect to be covered.

These pieces are placed upon the granulating surface and firmly pressed into place, so that they are in close contact throughout their area. Other pieces are placed quite near or even in contact with the edge of the first, and so on, until the space is entirely covered. Boric-acid dressing of any desired form is placed over them and superimposed by loose gauze and bandage.

The dressing should be left undisturbed for at least forty-eight hours, and then be gently removed and renewed. The utmost care should be exercised with the dressings, since here lies the success of the whole result. The blood dressings have given excellent results in cases undertaken by the author, and should be resorted to whenever practicable. The method has already been fully described, and does not differ in the event of employing zoödermic grafts.

When boric-acid dressings are used, they should be changed every day after the first dressing has been removed, so that the behavior of the grafts can be closely watched.

Lazy grafts and those showing signs of sloughing should be removed at once, and granulations crowding through the grafts should be snipped off with a fine scissors, as they are liable to destroy the life of a graft by pressure or by crowding it away from its bed of nourishment.

As in dermic grafts, the upper layers of these plaques will be thrown off, giving at times the appearance of total sloughing, yet on interference the deeper layers will be found to be intact and healthy. The dressings should be continued until the grafts have not only established their circulation, but until their edges have firmly united and the surface has taken on a dull reddish color, which eventually fades to a shade somewhat paler than the normal skin. The hairs that have been carried over with the grafts at first seem to thrive, but eventually drop out, leaving the surface bare. Spots of color so often observed in the skin of the bellies of dogs also disappear from the grafts, leaving their color uniform.

Amat, in 1895, claims that good results in skin-grafting are obtained by substituting the epidermal pin grafts with the film or inner-shell lining membrane of the fresh hen’s egg. For this purpose as fresh an egg as can be obtained is used. It is broken along the horizontal axis. A delicate forceps is now made to grasp the free membrane found at the air chamber of the enlarged end of the egg. The inner lining is drawn away from the shell in pieces four or five millimeters long; these pieces are cut with a fine scissors into equal lengths and placed with the point of the scissors to the granulating surface to be covered, in the same way as the Reverdin grafts. Amat covered the grafts with tinfoil, over which were placed several lays of carbolized gauze. The dressings were changed every three or four days.