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6
PLASTIC SURGERY

pieces of skin were kept detached for 18 minutes. In the third experiment larger pieces were used, 12.5×7.5 cm. (5×3 inches) including the cellular tissue and a bit of muscle. These were left detached for one hour before being transferred to opposite sides. All of the above-mentioned experiments were successful, and the grafts bled when cut into 10 to 12 days after the transplantation.

J. Mason Warren in 1843, used a successful free graft of whole thickness skin from the arm, to repair a defect on the ala following a rhinoplastic operation by the Italian method.

Netolitski, on April 11, 1869, successfully transplanted small elliptic shaped pieces of whole-thickness skin from the back of the patient's hand, in the treatment of a case of avulsion of the scalp.

The hastening of the healing of granulating wounds by the use of small detached bits of skin was first demonstrated by J.-L. Reverdin. His report was made to the Société Impériale de Chirurgie, December 8, 1869. He showed a patient on whom he had successfully practised "epidermic grafting," and described the grafts as consisting of epidermis only. He says "I raised with the point of a lancet two little flaps of epidermis from the right arm, taking care not to cut the dermis." These he applied to the granulating surface. He obtained his idea by observing the epithelial growth from a spontaneous island in an ulcer case. Reverdin's paper was discussed on December 15, 1869, but the importance of his method was not appreciated. He held that the living epidermis alone was necessary for the success of the graft, and that the transplanted epidermis caused the transformation of the embryonal cells of the granulation tissue into epidermic cells. Bryant, on the other hand, subsequently declared that the grafts themselves grew, and that there was a spread of epithelium from the graft, and this view has been proved correct, as it is now a well-known fact that epithelium is only derived from preexisting epithelium.

Pollock of London, heard of Reverdin's method in May, 1870. After trying it on several chronic cases he was very much impressed with his results and the method was immediately taken up by numerous surgeons in England, Scotland and Ireland. It soon became known in America, and in 1870-71 successful cases were reported by Frank Hamilton of New York, Chisholm of Baltimore, Coolidge of Boston, and others.

In his exhaustive paper on the subject published in 1872, Reverdin says in part: “The title 'epidermic grafts' is not perfectly correct, as the transplanted bit is composed of the whole epidermis and a very