SOME NOTES ON SKIN GRAFTING.
By Surgeon C Sibthoupe,
2,0th M. N.
I.,
Banda.
During the past year and a half I have had a good many opportunities of putting this mode of treatment into practice, and believe that it is one of the most powerful means we have of
securing a rapid cure and firm cicatrix in ulcers. of operation.?A small piece of the skin was taken up by means of an ordinary dressing forceps, and with a sharp scalpel it was cut, or rather shaved off, care being taken, if possiable, to avoid drawing blood. The piece removed was never more than an eighth of in inch in diameter, aud wa3 generally divided into two or more smaller portions upon the thumb nail, each division being placed separately at distances varying with the size of the ulcer, and gently pressed upon the granulations. The ulcer was then covered \yith guttapercha tissue, dipped in carbolic oil (1 to 40), which was kept in its place by a lightly applied bandage, and a little cotton to keep the guttapercha pressing the grafts against the granulations. The ulcers should be heathy, or at least only indolent, for if otherwise there i8 scarcely any chance of success: the class which appear to do best are those which are healing slowly from the edges ; the next and the surface are those in which cicatrization has ceasod, Mode
become indolent from want of power. If an ulcer is very large, soveral pieces should be transplanted, but it is generally better to wait and observe the result of
transplanting one or two pieces. If successful, there would be little difficulty found in persuading the patient to submit to a second operation. It is advisable not to remove the guttapercha
for the first three or four days, when care should be taken not to A fresh piece of guttapercha, disturb the surface of the sore. oiled as before, should bo re-applied and retained in its place by means of a light bandage so arranged as to permit of all discharges flowing freely away. The advantages of guttapercha tissue as a covering are many ; it is non-irritating and smooth; being semi-transparent, the state of the ulcer can be aeea without removing it.
THiJ INCiAN MEDICAL GAZETTE.
40
Generally, for the first fevV days, no change was perceptible grafts ; sometimes they seemed to have disappeared altogether. From the fifth to the eighth day the first signs noted were increased activity at the circumference of the ulcer, and an improvement in the appearance of the granulations ; on the ninth the grafts were found to bo or tenth day, sometimes later, increasing in size; and with the aid of a magnifying glass, slight bands of cicatricial tissue could be seen spreading excentrically; this in a few days would become perceptible to the
in the
naked eye.
Quickly each of the centres or islands of skin spread to meet rapidly contracting edge, the whole ulcer healing up with firm elastic skin, such as can never be obtained under ordinary
the a
treatment. Some of the cases treated were seen several months after; in none of them had sensation returned in the places which had healed from the grafts, though it was returning in the cicatrix
which had formed from the circumference. In none of the cases had pigment been developed to any extent in the cicatrix (most of the operations were performed on dark-skinned natives). Some of the grafts showed a small dark centre ; in others, it had increased in
size, though
the
pigment
was
paler
in colour
as
if
of the new cells, which had formed, contained pigIn only two cases have I met with bad results following ment. the grafting. It appeared to me in both cases that the ulcers,
only on
the
by
some
the fourth or fifth day, became itchy and irritable, causing patients to scratch them. This was followed in both instances an
unhealthy
failure.
patients.
state of the
In both instances
ulcer, causing in one case complete they were extremely unhealthy
[For?art 1,
1S75.
By Surgeon C Sibthoupe,
2,0th M. N.
I.,
Banda.
During the past year and a half I have had a good many opportunities of putting this mode of treatment into practice, and believe that it is one of the most powerful means we have of
securing a rapid cure and firm cicatrix in ulcers. of operation.?A small piece of the skin was taken up by means of an ordinary dressing forceps, and with a sharp scalpel it was cut, or rather shaved off, care being taken, if possiable, to avoid drawing blood. The piece removed was never more than an eighth of in inch in diameter, aud wa3 generally divided into two or more smaller portions upon the thumb nail, each division being placed separately at distances varying with the size of the ulcer, and gently pressed upon the granulations. The ulcer was then covered \yith guttapercha tissue, dipped in carbolic oil (1 to 40), which was kept in its place by a lightly applied bandage, and a little cotton to keep the guttapercha pressing the grafts against the granulations. The ulcers should be heathy, or at least only indolent, for if otherwise there i8 scarcely any chance of success: the class which appear to do best are those which are healing slowly from the edges ; the next and the surface are those in which cicatrization has ceasod, Mode
become indolent from want of power. If an ulcer is very large, soveral pieces should be transplanted, but it is generally better to wait and observe the result of
transplanting one or two pieces. If successful, there would be little difficulty found in persuading the patient to submit to a second operation. It is advisable not to remove the guttapercha
for the first three or four days, when care should be taken not to A fresh piece of guttapercha, disturb the surface of the sore. oiled as before, should bo re-applied and retained in its place by means of a light bandage so arranged as to permit of all discharges flowing freely away. The advantages of guttapercha tissue as a covering are many ; it is non-irritating and smooth; being semi-transparent, the state of the ulcer can be aeea without removing it.
THiJ INCiAN MEDICAL GAZETTE.
40
Generally, for the first fevV days, no change was perceptible grafts ; sometimes they seemed to have disappeared altogether. From the fifth to the eighth day the first signs noted were increased activity at the circumference of the ulcer, and an improvement in the appearance of the granulations ; on the ninth the grafts were found to bo or tenth day, sometimes later, increasing in size; and with the aid of a magnifying glass, slight bands of cicatricial tissue could be seen spreading excentrically; this in a few days would become perceptible to the
in the
naked eye.
Quickly each of the centres or islands of skin spread to meet rapidly contracting edge, the whole ulcer healing up with firm elastic skin, such as can never be obtained under ordinary
the a
treatment. Some of the cases treated were seen several months after; in none of them had sensation returned in the places which had healed from the grafts, though it was returning in the cicatrix
which had formed from the circumference. In none of the cases had pigment been developed to any extent in the cicatrix (most of the operations were performed on dark-skinned natives). Some of the grafts showed a small dark centre ; in others, it had increased in
size, though
the
pigment
was
paler
in colour
as
if
of the new cells, which had formed, contained pigIn only two cases have I met with bad results following ment. the grafting. It appeared to me in both cases that the ulcers,
only on
the
by
some
the fourth or fifth day, became itchy and irritable, causing patients to scratch them. This was followed in both instances an
unhealthy
failure.
patients.
state of the
In both instances
ulcer, causing in one case complete they were extremely unhealthy
[For?art 1,
1S75.
