and deltoid region, to fill defects left by relieving contractures of the neck and chin following burns.
Joseph Pancoast of Philadelphia, in 1842, reported the successful use of pedunculated flaps from the cheeks, forehead and upper lip.
Frank H. Hamilton, on January 21, 1854, in the Buffalo General Hospital, raised a pedunculated flap of skin and subcutaneous fat 10. × 17.5 cm (4×7 inches), from the calf of a man's leg for the relief of a large traumatic ulcer of the other leg. This flap was held away from its bed with dressings and remained viable, although there was a considerable degree of shrinkage. After two weeks he freshened the under surface and edges of the flap, excised the ulcer and part of the cicatrix, then partly covered the wound with the flap and secured the legs together. Two weeks later the flap was amputated from its base, but a portion of it subsequently sloughed. It is interesting to know that, ten years before this operation was performed, Hamilton had suggested this procedure for the relief of an ulcer of the thigh, but had been unable to obtain the patient's consent. He recognized the important fact that if a graft is smaller than the chasm which it is intended to fill, it will grow or project from itself new skin to supply the deficiency, and hence that it is not necessary to make the graft as large as the defect to be covered. No wide interest, however, was evoked by Hamilton's report.
After this there were reports on the subject from the United States, England, France and Germany, but it was not until the work of Maas, 1884-86, that widespread attention was given to the use of pedunculated flaps. His papers were so convincing that a new impetus was given to the method. Since his death there has been much work done on these lines by many surgeons, and splendid results have been reported.
The original Indian and Italian methods have been modified from time to time, but their basic principles are unchanged.
THE DEVELOPMENT OF SKIN TRANSPLANTATION
In 1804, Baronio, the physiologist, did the following experiments, which he carried out on sheep:
In the first experiment, two whole-thickness pieces of skin of equal size and exclusive of the subcutaneous tissue, were cut from either side of the root of the tail of a sheep, and were immediately transferred to opposite sides. The second experiment was similar, except that the
