CHAPTER XXVIII. SKIN GRAFTING.
Skin grafting is a measure deserving to be more generally employed by the practitioner. Very often it would save time and trouble in the treatment of those conditions in which epidermitization is long de- layed, for this it hastens and also it tends to prevent the formation of Scar tissue. Thus chronic ulcers, burns, and lacerated wounds fol- Jowed by extensive sloughs may require grafting.
The operation is simple in theory yet attended by many failures through lack of attention to detail,
‘Three factors require the minutest supervision; (1) the field must be properly prepared; (2) the grafts must be cut correctly; (3) the after-treatment must be appropriate.
(2) The area to be grafted must be sterile and must be free of any oozing. If an ulcer is to be treated, the granulations must previously be made as healthy as possible: if sluggish, by currettement; if exuber~ ant, by touching up with nitrate of silver, A few days afterward it will be ready to receive the graft. A dry sterile dressing should be applied a day previous to the operation; before the graft is applied, the surface should be thoroughly douched with normal salt sobution
(2) The skin which is to furnish the graft should be shaved and thoroughly scrubbed with soap and water. Antiseptics had better he avoided for they may compromise the vitality of the cellular ele~ ments. A sufficient anesthesia may be obtained by injection of Schleich’s solution No. 3.
Two methods of cutting the grafts are currently employed, Rever- din’s and Thiersch's.
(1) Reverdin’s Method.—A small fold of the skin is picked up with fine tissue or mouse-toothed forceps and cut off at its base with small pointed scissors (Fig. 598). This section includes practically all the layers of the skin (Fig. 599). The graft is applied and gently yresses.
7
a
THIERSCH'S METHOD. 729
‘The grafts in this case consist of thin slices of the epidermis, as long a5 necessary and as wide ag convenient. ‘They are usually taken from
Pic. or—Thiersch's methods Preparing the wound for the graft, (Vea)
the anterior surface of the thigh, A sharp, thin-bladed razor is used in cutting the slice (Fig. 602).
m Pio. 6or.—Cutting the Thisrech pratt. (Veo)
‘The skin must be put on the stretch. Special retractors are occa- sionally employed. The two'hands of the assistant and Woe ium
THIERSCA’S* METHOD, 73
| layer of gauze saturated with salt solution is next applied, which in | turn is covered by absorbent cotton, and the whole held in place by a i moderately firm bandage.
= fing the Pia. 60s.—Wound covered Bro, b04—-Mathod of apolving 0. 605 — Wound covere by
The part should be immobilized, employing plaster splints If neces- sary. Change all the dressings except the rubber tissue every day or two and douche gently with normal salt solution, At the end of a week or ten days, change the tissue.
INDEX.
Abdomen, contusions, 112 gunshot wounds, 134, 145, 159 incised wounds, 116 injuries, 112 laparotomy, 113 non-penetrating wounds, 114 penetrating wounds, #1§ punctured wounds, 115 stab wounds, 115
Abdominal drainage, 117 hemorrhage, 405 section, 463
Abducens nerve, 297
Abscess, acute, 312 alveolar, 321 antrum, mastoid, 455 appendicial, 503
axillary, 332
Bartholin's gland, 546 breast, 33°
cervical glands, 329 chromic, 31§ definitions, 312 dental, 321
drainage, 314
eyelids, 318
‘external auditory meatas, 319 face, 327
floor of the mouth, 325 iliac, 355 ischio-rectal, 337 kidney, 484
labium, 346 lachrynal, 319
liver, 351
Jung, 436
mammary, 346 mastoid, 455
fasal septum, 518 palmar, 335
parotid, 320
pelvic, 348
peri-anal, 340
Abscess, perineal, 344 Plantar, 337 popliteal, 335 prostatic, 341 pees, 355
1 340 retropharyngesl, 326 saalp subaponeurotic, 316
subperiosteal, 517
superficial, 516 seminal ducts, 345 submaxillary, 323 submammary, 332 subphronic, 351 symptoms ol, 312 tongue, 325 tonsillar, 325 treatment, acute, 313
chronic, 315 urinary, 633 vulvar, 346 vulvo-vaginal, 346
"Accidents, anesthesia, 4
Acupressure, 58
Acute intestinal obstruction, 998 getention of urine, 61g
Actual cautery, phlegmon, 368
Adrenalin chloride anesthesia, +4 epistaxis, 6¢ gauze tape, br shock, 52
Air passages, foreign bodies, 306
barns, 409 Alcohol, untisepsls, 4 Allison, strangulated hernia, 339 Alveolar abscems, 321 Ammoni: iter anesthesia, 16 Amputations, arm, 656 atypical, 650 . Chopart, 6&y elbow, 670 finger, 657 foot, 684
733
Astimgalus, ‘Mtocation. a7 Auditory nerve, injuries, 2 ‘Automatic centers, paralyaa ‘Axillary artery, Yeation ts te, 334 seamen ay Axtell, wound of chest, 107 trephining, 453
Bandage, Barton's, 44 asec breast, at
a 43
Senet ixees, a6 4 sat S
age 2 of Ht applyiog, 35
plaster, Barthoti ihod, sae 6 [embeceg eer ah | Base of thorax, wounds, 108 ee operation for
| Bova, splints,
Betlocats cannula, 66, Beate ‘Sir W,, torsions, s92
Belfield, drainage ba ‘seminal ducts,
735
Bleeding (see Hemorrhage) Bloodgood, intestinal obstruction,
0 aloes
Blood veusels, injuries, 88-90
Boldt, scopolamine narcosis, 14
Rolo wounds, 146
Hone wiring, 216
Bonney, emergency operations, 6
Bowel, acute obstruction, 508
Bowls sterilization, 16
compression, 176 concussion, 174 contusion, 176 gmabet wounds, 129, 143 mmorrhage, 444 injuries, 169 +44 Branctel creas Broast abscesses, 330 Brickner, fabs rickner, tubal pregnaney, 598 Bronchi, foreign b bodies 396 Bronchoscopy, 398 Brown, Cesarean section, 606 Bruises (see Contused wounds) Brushes, hand, 2 Bryant, esophagotomy, 422 Bullet wounds, civil, 155 mili 133 Bullets, types, 193 Burns and scalds, 205 Burns, air p Burns, electri Burns, mouth, 409
6 artery Te ation, es dislocation, 276
ney, fracture of femur, 231
‘trephine, 448
eo dominal. 217 ceecaen 3: Residents! wounds, 31 tions, 6:
3° infiltration, 637 2 149
Edema of ghottis, 419
Elbow, amputation, 670 arthrotomy, fracture, 236 gunshot wounds, 143 wound, 90
Electrical tans ato
abock, 4 Elliott, wounds of kidney, 484 Emergency antisepais, 6
EOFS, puncture for, 438 Enemas, technic, st Enterostomy, $19 Enterectomy, $73 Ey 395 teens)
juiptent, Cate 2 Eemarch bondage 63 Esophagotomy, 420 Esophagus, foreign beries, 392
wounds, 85 Estes, iptessenewpti
adrenalin chloride in, 14 External auditory meatus atscons,
Higation, 641
tra-capsular tincture, 324 sation of urine, 6x5 remities, fractures, 133
Eye foreign bodves, 288
INDEX.
Practures, radius, 210 reduction, 191 ribs, 183 scapula, 245 skull, 169
compound, 173 supracondylar, 2¢5, spine, 173 splints, 103 tarsus, 250 thumb, 223 tibia, 236 toes, 950 treatment, 19 ulna, 7£0 vertebra, 178 wrist, 219
Preexing, 411
Frost bite, 405 uncle of face, 317
Fysche, gunshot wound, 160
Gage, rupture quadriceps extensor, 285
Gangrene, amputation, 649 Gastric lavage, 14, $10 Gastro-enterostomy, 478 Gause, 4
dressings, 32
drainage, 50 General practitioner as emergency
surgeon, 1 Genito-crural nerve injury, 307 Gerster, treatment of peritonitis,
S07 Gibbon, suture of heart, 450 Gloves, rubber, 9 Gluteal hernia,’ 556 Gooch’s splint, 45 Granger, burns, 409 Great tow, 681 Groin, bandage, 38 Guibal, subphrenic abscess, 351 Gunshot fractures, 136 wound of abdomen, 134, 145,
739
Gunshot wound of intestine, 135 joints, 226, tar, 165 ridney, 135 knee, ¥42, 363 liver, 135 lungs, 132 neck, 144, 157 nerves, £23 panercas, 135 rectum, 335 skull, 130, 143 spine, 13 145, 257 een, 135 omach, 13$ thorax, 133, 148, 158 trachea, T44 wounds, civil, x55 effects on tissues, 122 hemorrhage, 122 military, 122 prognosis, 135 shock, 133 suicidal, 156 treatment, 235 Gun-splint, 154 Guyon, catheterization, 626
Hand, abscess, 335 amputations, 664 bandages, 42 brushes, 2 fractures, 939 gunshot wound, 164
. o Harrington's solution, 10 Harsha, torsions, $92 jartmann, splenectomy, $95
Havard, gunshot wounds, 134, 195 Hayes, peritonitis, 926 Haynes, wounds of liver, 479 Head, wounds, 78
bandages, 44 Heart, gunshot wounds, 153
wounds, 119
massage, 15
ropair, 425
suture, 430 Helle, treatment of ileus, 518 Hemarthrosin, 149, 164 Hematoma, 70 Hematuria, 436 Hemopericardiusn, va
ues oa
cotopi fatal, firs forcipressure, 59 heat, 57 Gdermoclysis, 56 fusion, intravenous, 56 internal, 54 intermediary, 54 kidney, 473 laparotomy, 465 liver, 473 meningeal, 170 mesentery, 473 normal salt solution, 56 operative, 50 parenchymatous, 54 primary, 54 secondary, 54 spleen, 473 spontaneous arrest, 57 symptoms, 54 torsion, 59 tourniqucts, 58 treatment, 55 tubal pregnancy, 597 venous, 54 Hemorrhoids, operations, 704 Hemostasis, §7 Hemothorax, 100, 133 Hennequin’s dressing, 197 Hernia, appendix, 544
rupture, su7
nish ate
nomalies, §42 Hernio-laparotomy, 542 Hertzfeld, epistaxis, 66 Hilton, abscess, 335 Hip-joint, arthrotomy, 385
amputations, 698
dislocations, 270
gun-shot wounds, 142 Hodgen’s splint, rat Holliday, splenectomy, 482 Humerus, fractures, 195
gunshot, 139
fower end, 202
shaft, 195
surgical neck, 200
upper end, 198
osteomyelitis, 374 Hunt, tubal pregnancy, 603 Hydrocele, 716
radical operation, 717
tapping, 716 Hypodermoclysis, 56 Hysterectomy, 603
Ice, appendicitis, 493 Tleus, postoperati: 8S, 356 inguinal nerve injury, 307 perforate anus, 584
17
Im Incised wounds, 70
Inguinal hernia, strangulated,
Injuries, abdomen, a joints, a52 reMedey
p hand,
Instruments, emergency, 4 clean: $s %
preparation, Tetecooead usar) eeasorrbeae] 6 artery, 65
43. tubal pregnani ye Totestinal anastomosis, 573 obstruction, acute, 508 gastric vax, sie arotomy, 5t2
hemor ana Intravenous infusion, hemorrhage,
shel, $3 “ teohnic, 56 intussusception, Tedine, sterilization of ‘the skin, 10
Irrigator, ‘dt Ischiotic dislocation, 274 Tschio-rectal abscoss, 337 Jaw, dislocation, 266 fracture, 180 gunshot, 157 Joints, contusions, 281 dislocations, 2¢2 8
Kidney, injuries, a8s removal,
wounds, 483 Killian, bronchoscopy, 398 King, fracture of extremities, 185 Knott, suture of liver, 479 Kollman, filiform guide, 625 Kolmer, reun section, Konig, preparation of the skin, 19 Knee, amputation, 695 arthrotemy, 377 bandage, 37
Katner, wounds of hung, 159 Kyle, foreign body in nase, 392
Labium, abscess, 346
Lacerated wounds, 73
Laceration of brain, 169 Lachrymal abscess, 319 Lanphear, Cesarean section, 605 Laparotomy for Cesarean section
general technic, 463 gunshot wounds, civil, 159 military, 145° intestinal obstruction, 510 for traumativm, 459 Laplace, peritonitis, 507 Laryngatomy, 426 Larynx, foreign bodies, 396 ‘wounds, 8s anastomosis, intestine, 380 sinus thrombosis, 485 Lavage, gastric, 14, 510 Leg, amputations, 698 bandage, 36 fractures, 296 oxteomyslitis, 372 Lojars, appendicitis, 493 reduction of shoulder, 253 thumb, 269 rupture of the lung, roy splint for leg, 239 preparations for operation, 7 Lembert suture, 976 Lichteretern, Sots, $65
Tat
INDEX. 743
7 musculo-cutancous, 508 museulo-spiral, 31 obturator, 306
optic,
Perovenl, 308
phrenic, ‘297
pneu: rie, 207
Fai
radial, 308
recurrent laryngeal, 297 selatic, so7
tibial anterior, 309
or, trifacial, 297 ulnar, 299 Noble, Cesarean section, 606 Noetzel, wounds of spleen, 482 Note, foreign bodies, sox hemorrhage, 65
Obturator artery ligation, 36 dislocation, 276 hornia, atrangulated, 554 nerve, 305 Occipital artery ligation, 64: demu of the glottis, 419 CGsophagotomy, 420 Esophagus, foreign bodies, 992 injuries, e) Ointment of Reclus, 408 Olecranon, fracture, 216 Otiver, strangulated hernia, $45 jaw fracture, 181 Omentum, hemorrhage, 47 resection, 568 torsion, sy Open wounds of thorax, 104 Operative wounds, 71 ‘Operation in private houses, 6 Opium, appendicitis, 493 Optic nerve injury, 290
Os calcix, Pirogofl's amputation,
689 Oschner, appendicitis, 494 femoral hernia, 460 torsion, 597
Osteomyelitis, acute, 369 feraur, 374 humerus, 574 tibia, 37> Ovarian eysts, torsion of pedicle,soo
wenstecher, linen, 24 Palmar abscess, 335 ‘arches, 65 Panasis, 359 Pancreag gunshot wounds, 135 injuries, 481 suture, 481 Paraphimasis, 710 Paracenteeis, eardruni,.456 pericardium, 433 pleura, 4 Pardtid gland ebecesd, 360 Patella, dislocation, 27} fracture, 231 wiring, 335 Peek, wounds of heart, 433 Pedicles, ligation, 590 Pelvic abscess, 343 Pelvis, fractures, 245 Penis, injuries, 135 Perborate of sods, epistaxis, 67 Peri-anal abscess, 340 Pericardiotomy, 43s Perleardium, paracentesis, 433 puncture, 433 suture, 430 wounds, Fo Perineal abscess, 341 bruises, 635 section, 636 Peritonitis, purulent, 506 treatment, 507 typhoid, so septic, Peroneal
pregnancy, oz Phalanges, fractures, 9270 Pharyax, foreign bodies, 392 Phirnosis, ;10 Phlegmon, 362
arm, 366
fingers, 362
forearm, 365
neck, 367
perineum, 635
tendon sheaths, yoo Phrenic nerve, 297
TRDEX,
Scopolamine narcosis, 1. Scrotum, jajurien 518” Scudder, fracture of leg, 230
Sebaceous wal, 724 Seconlacy Hemorth Semfluna? cardlager, dislocation,
Seminal ducts abscess,
Senn, firstald op batticlichd, raf Gacvare of = 2
ition, hip join a ee 699
Shoulder amspusation, 674 arthrotomy, 385
ba: 42 dinhoctions, 959 Sorte wounds, 146
Dg, 727
praralion, 10
skull, Ball i, Bullet wotunds, 27, 155 fracture, tinse, 169 compoun’
aja
it, trephink Sponce, shoulder amputation, 680 Speematic cord, ligation, 720 tonion, og3
179
Spine, tactures Say
inshot weninds, 130, 157 ‘wounds, tr
n, hemor injuries, 481
a
745
6 Laster-of-Paris, 46 te of potash, 45
wooden, 45
wire ganee, 46 Sprains, 82
. Andrew's crags, 40 Stat ‘wounds, 72
abdomen, 115
thigh, 88 thorax, 104 Sterilization, dressing, 7 nds, 9 instruments, & akin, 10 Stimson, pain in fructure, 199 Stomach, hemorrhage. 135 hornin, s4§ suture, 478 wounds, 438 Stewart, euture of heart, ase Stovaine, spinal anesthesa, 20 Strangulated hernia, 528 complications, sat diagnosis, sz femoral, 55% inguinal, 533 obturator, ‘operation, 535 taxis, 530 umbilical, 49 Stricture of urethra, 629 Stump bandage, 45 Subclavian artery, compression, 63 ligation, 64 Subclavicular ditlocation, a56 Subcutaneous wounds, 69 Subenticalar sutam, 38 ncation, 202 abscess, 382 Subnasaliacs alco, x2
Suttire ot arteries, 038 Marder, 486 heart, 4 intestine, 475 hver, 479 lung, 425 nerves, 294 pancreas, 481 tendons, '289 ureter, 486 wounds, 23 Sutures, catgut, 24 continuous, 24 horsehair, 23 interrupted, 5 Lembert, 476 linen, a4 methods and materials, 23 quilted, 24 sero-serous, 476 sill, 23 silkworm-gut, 25 subcuticular, 28 Syme's amputation, 687 Syncope, 55 Synovial sheath suppurations, 361 cysts, 726
Tampon for intercostal hemor- thage, 65 Tapping, hydrocele, 716 -so-metatarsal, amputation, 683 ursus, dislocations, 277 fracture, 250
propanyeesss +
janet
ewes ot Inerseh, skin grattnc. tet high put ee Thoracetemy, mint . technic, Thorax, injuries Throat, cut, 83 Thrombosis, lateral sinus, 45: Thumb, amputations, 661 bandage, 41 dislocations, 268 fracture, 223 Tibia, fractures, 236 ‘osteomyelitis, 372 trephining, 373 Tibial arteries, ligation, 646 compression, 64 Tillaux’s dressing, 228 Toe-nail, ingrowing, 721 Toes, amputation, 680 Tongue, abscess, 325 suture, 82 wounds, 82 Tongue-traction, asphyxia, 11 abscess, 325 Torsion, arteries, 59 diagnosis, s89 omentum, 596 pedicle ovarian cysts, 589 spleen, sos spermatic cord, 593 uterus, 591 Townsend, catheterization, 6; Trachea, foreign bodies, 396
ry
INDEX.
Trephining, tibia, 372 Trephine, Doyen, 378 Galt, 448 Troves, strangulated hernia, 538 Trunk injuries, 99 Tubal pregnancy, diagnosis, sp8 operation, $99 rupture, iBuberéaias abscoon, 49 ‘Tumors, superficial, 724 Turpentine burns, 408 Tunica vaginalis, ee Tuttle, imperforate anus, 5! ‘Typhoid perforation, so7
Ulna, fractures, 210 Ulnar artery, ligation, 645 nerve exposure, 299 injury, 299 kynovial shenth, 363 Umbilical hernia, ‘strangulated, $49 radical care, 550 Ureter, repair, 487 wounds, 487 Urethra, anatomy, Gre catheterization, 620 contusions, 611 foreign boding, 402 rupture bulbous portion, 612 diagnosis, 68 membranous portion, 618 pendulous portion, 618 symptoms, 609 treatment, 619 Urethral forceps, 403 Urethrotamy, 619 Urgent craniectomy, 444 _ thoracotomy, 423 iry abscess, 635 Ic, extravasation, 653 Tetention, 619 Uterus, torsions, gor
der Walker, surgery, 6
Van emergency
Vagus nerve, 297 4
Van Hook's anastomesis, 487
Valentine, emergency cathetoriza tion, 622
Vasectomy, 345
Vaughn, wounds of heart, r2
rir
Vault of slcull fracture, rye compound, #75
Veins of liver, ligation, 479
Velpeau’s bandage, 1&4
Venous hemorrhage, 54
Vincent, trephining, 4s
Vinebery, tubal pregnancy, 998
Vertebrer, fractures, 178
Viscera, abdominal, rapture, 125
Volvuliis, 10
Von Bergman, gunshot wounds,
x
7
Vulvar abscess, 346
Vulvo-vaginal abscess, 546 injuries, 118
Waite, shock, 49 Walker, fractures of femur, Warbasse, treatment of fmeture,
193 Wathen, wounds of liver, 470 Westmoreland, tracheotomy, 417 Whitman, fracture of femur, 227 Wick drains, go fire gauze splints, 4 Wirn fractured fagers, 222 olecranon, 916 patella, 235 Wooden splints, 45 Wounds, abdomen, 114 aseptic, 70 tase of thorax, 108 bend of elbow, go bladder, 485 blank cartridge, 166 bolo, 146 chest, roy cleansing, 75 contuse” dy definitions, 68 diaphragm, 110 drainage, 8 dreasings, 75 elbow, 90 eye, 85 wyolida, So extremities, $7 face, 8 femoral artery, 88 fingers, 95 ‘general principles, 68 gunshot, civil, 155 military, 125 band, 96
748
Wounds, head, 78 heart, 110 hemorrhage, 7° incised, 70 infected, 76 intestine, 475 kidney, 483 lacerated, 73 larynx, 85 lips, 81 Liver, 478 tang 105 neck, 85 operative, 71 pancreas, 481 penis, 118 pericardium, tro pinna, 80 pleura, 20+ precordial, rro punctured, 73 Teetum, 124
nS i, 146
I regions, 78 117
INDEX.
Wounds, spleen, 48x stab, 72 stomach, 478 subcutaneous, 69 suture, 24 symptoms, 69 testicle, 119 thigh, 85 thorax, 99 trachea, 85, treatment, 70 tongue, 82 toy pistols, 266 ureter, vagina, 118 vulva, 378
wrist, 88 Wrist, arthrotomy, 384 dislocation, ao fractures, 319
wounds, 88
“4
Zone of anesthesia, 18