The Split Skin Graft

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EIGHTY-THREE years have passed since Reverdin described the first practical approach to the autogenous free grafting of human skin. He proposed the use of small thin bits of skin later known as “pinch grafts.” Oilier and Thiersch, in 1872 and 1874 respectively, grafted larger pieces of very thin split skin, thus enlarging somewhat the scope of the graft’s usefulness. There is little in the literature to suggest that skin grafts were especially popular from a surgical standpoint during the next 50 years. However, in 1929, Blair and Brown1 introduced the thick split graft, and demonstrated vast possibilities for its use. Since then, the split skin graft has become increasingly valuable, not only to the plastic surgeon, but to the general surgeon as well. Developments in recent years have consisted mainly of ingenious machines to cut skin of uniform thickness, and at the same time eliminate much of the need for skill required in free-hand cutting of skin. The most notable of these is the Padgett dermatome,2 which was first used in 1938 and has remained to date as the most generally useful of these instruments.

There has been a tendency in some circles to surround the grafting of skin with considerable mystery, and to suggest that grafts will “take” only for specially endowed surgeons. At the same time, surgeons are often perfectly satisfied with the survival of half or two-thirds of a graft. Both of these attitudes are regrettable. A skin graft of suitable thickness, placed on a properly prepared. . .



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