The San Francisco call. [volume] (San Francisco [Calif.]) 1895-1913, 1895-07-23
SKIN GRATING METHODS,
Two Cases of Transpianting
Cuticle at the City and
County Hospital.
BOTH WILL BE SUCCESSFUL.
Not a Dangerous Operation, but
One Requiring Great Skill
In the Surgeon.

There are two interesting cases of skin
grating at present under treatment at the
City and County Hospital. They are in
teresting not only surgically, but to the
general non-scientific reader as well.
The last operation was performed Satur-
day on the person of John Hurley. He
entered the hospital on the 18th of June,
suffering from stubborn liberated sore
on his right leg, between the knee and
ankle. 1t was first caused, and subse-
quently aggravated, by the wearing of
heavy boots. Hurley was employed in
slaughter-house, and his feet were COM
monty damp, which circumstance, COM
bined with the harshness of the leather of
his boots, is supposed to have produced an
abrasion of the skin.
At the time he entered the hospital the
sore was in a serious condition, and ampu-
tation was the only alternative in case the
sldn-grafting should not prove successful.
Accordingly several strips of skin were
shaved from his left leg, near the thigh,
and applied to the surface of the stubborn
and unhealing sore. DR.. Stillman per-
formed the operation. 1t proved highly
successful, and when examined yesterday
it was found the transplanted cuticle had
taken graft and was rapidly covering the
surface of the sore with healthy skin.
Though very delicate and careful, the
operation is not as critical as might be
supposed. Under the Riverdam method
the skarf-skin is shaved off that portion of
the patient body selected for the purpose
with a very sharp razor. In this instance
it was the left leg, near the thigh. The
leg was tightly bandaged above and below
the spot where the skin was to be taken
off, so as to present to the steel a smooth,
slightly raised surface. The surgeon holds
the razor III almost the same position as
barber would handle it in removing
three days stubble from the tender cheek
Of favorite patron. The skin is shaved
off in thin strips, a half or three-quarters
of an inch in width, the length varying ac
cording to the area which it is desired to
cover. The entire cuticle is not removed.
The strips are about half the thickness of
the natural skin, the shaving being merely
deep enough to cause slight oozing Of the
blood from the barred surface
The sore on Hurley leg was about three
and half inches in width by five and q
half in length. Several strips therefore
were required from the healthyspot on the
left thigh. The shaving off of the healthy
skin is very painful, and the patient was
kept under the influence of anesthetics
during the operation. After the new skin
is applied it is bandaged loosely but firmly
so as TO prevent any OF the strips of skin |
from being displaced. For twenty-four
hours or less the new skin is kept satu-
rated with II per cent salt solution,
which is about equivalent to the saline
percentage of the blood. This stimulates |
and nourishes the cuticle growth. After
ward mild antiseptic solution is applied |
Hurley's sore will heal perfectly, and he |
will have healthy, strong leg.
In the other case-that of man named |
Nelson, who was burned by the explosion |
of lamp on the 18th of June-a different
method was employed in connection with |
the Riverdam. The surface of the burn |
was nearly ten inches in diameter. In
stead of taking the grating skin In strips
1t was removed IN minute patches and APP |
piled to the raw surface of the burn about |
half or Jhree-quarters of an inch apart. A |
needle-like instrument and curved scissors |
are used in taking up the healthy cpl !
dermis. Small patches are raised from !
the surface by means of the needle and |
while being so held the sharp blades of the |
scissors sever it from the body. Some of |
these patches are so small as to be almost |
invisible to the unassisted eye when APP |
piled to the raw surface of the sore. When |
they begin to take the graft these minute |
particles of healthy cuticle spread over |
the entire sore until they finally unite in a |
solid healthy surface. This is called the |
Thiersch method.
The strips were also used on portion of |
Nelson's burn, and owing to the relative |
position of the sore and the spot from |
which the new cuticle was taken, the strips |
were placed in a saline solution when first |
taken off by the razor. The burn was on |
the right side of the body, between the |
waist and armpit, and the healthy skin |
was taken from the left thigh. Conse- |
quently the patient had to be turned over |
after the operation OF shaving the cuticle |
was performed. The salt solution kept the |
skarf-skin fresh and moist until the sur |
geons were ready to apply it piece by piece
to the receptive surface.
In every case the surface of the body |
whence the gratis are taken, as well as
the sore ITSELF has to be thoroughly |
cleansed before the knife is used
Both operations will prove successful, |
though that of the burn will prove more |
tardy in healing.