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#Methods of Skin-Grafting.# Two methods are employed: one in which the epidermis is mainly or exclusively employed epidermis or epithelial grafting; the other, in which the graft consists of the whole thickness of the true skin cutis-grafting. Epidermis or Epithelial Grafting. The method introduced by the late Professor Thiersch of Leipsic is that almost universally practised.
The frog skin was transferred to the left buttocks, and on the right buttocks eight long strips of white skin were transferred after the manner of Thiersch. A strip of human skin was placed in one section over the frog skin, but became necrotic in four days, not being attached to the granulating surface. The man was discharged cured in six months.
Rickly can lend me, and the Osterwald geography, which does not accord with the new divisions; I must have Ritter or Malte-Brun; 3rd, for Greek I need a new grammar, and I shall choose Thiersch; 4th, I have no Italian dictionary, except one lent me by Mr. Moltz; I must have one; 5th, for Latin I need a larger grammar than the one I have, and I should like Seyfert; 6th, Mr.
Recently amalgam fillings have been used in bone-cavities to supplant grafting. In destructive injuries of the skin, various materials were formerly used in grafting, none of which, however, have produced the same good effect as the use of skin by the Thiersch Method, which will be described later.
The discharges, according to the experiments of Thiersch, Burdon-Sanderson, and Macnamara, are not virulent and poisonous for the first twenty-four hours; on the second day eleven per cent. of those who swallow them will suffer; on the third day, thirty-six per cent.; on the fourth day, ninety per cent.; on the fifth day, seventy-one per cent.; on the sixth day, forty per cent.; and after that the discharges have no effect the bacteria die, and the poison becomes inert.
Gockelius speaks of self-castration in a ruptured man, and Golding, Guyon, Louis, Laugier, the Ephemerides, Alix, Marstral, and others, record instances of self-castration. In his Essays Montaigne mentions an instance of complete castration performed by the individual himself. Thiersch mentions a case of a man who circumcised himself when eighteen.
Thiersch contends that healing of a granulated surface results first from a conversion of the soft, vascular granulation-papillae, by contraction of some of their elements into young connective-tissue cells, into "dry, cicatricial papillae," actually approximating the surrounding tissues, thus diminishing the area to be covered by epidermis; and, secondly, by the covering of these papillae by epidermic cells.
"I wish," so it runs, "to advance in the sciences, and for that I need d'Anville, Ritter, an Italian dictionary, a Strabo in Greek, Mannert and Thiersch; and also the works of Malte-Brun and Seyfert.
Thiersch therefore recommends that for the prevention of cicatricial contraction, the grafting be performed with large strips of skin. Harte gives illustrations of a case of extensive skin-grafting on the thigh from six inches above the great trochanter well over the median line anteriorly and over the buttock.
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