This is a Cobbett Skin Grafting Knife- donated to Earthwide Surgical Foundation by Integra Lifesciences for our plastic surgery work in Nigeria. Grafts can be done without such a knife but they rarely come out as well. This knife is a real beauty!
The history of skin grafts has its beginnings in ancient
India, where Sanskrit texts document skin transplants performed by Hindus in
3000-2500 BC (1-3). Potters and tilemakers of the Koomas caste were
reconstructing noses which had been mutilated as punishment for crimes such as
theft and adultery. Grafts were obtained from buttock skin, which was
reportedly slapped with a wooden paddle until red and congested, and then cut
with a leaf to the appropriate size (3-5).
Despite early attempts at plastic and reconstructive
surgery, hundreds of years passed until further work advanced the practice of
skin transplantation. In Italy in 1442 AD, Brancas developed a novel technique
of binding the patient's arm to the site of the skin graft (3). Brancas used
skin from the arm to transplant a slave's nose to his master's nose. He
unfortunately did not receive recognition for his technique of nasal
reconstruction, which was instead credited to his fellow countryman,
Tagliacozzi, over a hundred years later. Tagliacozzi, who is considered to be
the pioneer of modern plastic surgery, publicized Brancas' method of skin
grafting. Although he repaired soldiers' facial battle wounds, the most common
reason for nose deformities at that time was tissue infection due to syphilis.
In 1597, Tagliacozzi published his work in "De curtorum chirurgia per insitionem,"
and in so doing, transformed plastic surgery from a trade service to a
scientific procedure (3).
In 1804 Baronio demonstrated the first
successful autograft using the backs of sheep (4). By 1823, Bunger achieved
the same success with autografts in human subjects. Attempting to revive the
ancient Indian method of rhinoplasty, Bunger repaired nasal defects using
full-thickness skin grafts from the patient's thigh (3,4). In 1869, the Swiss
surgeon Reverdin performed
the first allograft by pinch grafting very thin pieces of epidermis ('epidermic
grafts') (3,9). Using this first split-thickness skin graft, Reverdin
demonstrated a more rapid healing of granulating wounds. Two years later,
Oilier furthered Reverdin's work and demonstrated a better outcome by using
skin grafts that were not only composed of epidermis, but also contained a
portion of the dermis (3,4,10). These 'dermoepidermic' grafts effected faster
wound healing with less scarring. In 1871 Pollock introduced the idea of using
skin grafts to treat burn wounds (11,12). He donated small pieces of his own
skin which he used in conjunction with a burn victim's skin to cover a large
denuded area. The idea was brilliant and paved the way for one of the most
important modern functions of skin grafts, the treatment of burn victims. By
the end of the century, Wolfe (13) had introduced full-thickness skin grafts
into clinical practice to treat ectropion, and Girdner (14) had published the
first report of skin grafting with human cadaveric skin.
The use of skin grafts revolutionized the care
and ultimately the mortality of burn patients. However, problems arose because
donor grafts uniformly died. Research in the twentieth century thus began with
attempts to understand the physiology of graft survival (15). It was not until
1943 that Medawar and Gibson discovered that the rejection of transplanted skin
was mediated by the body's immune system (16). The 1940s also witnessed the use
of refrigerated skin as a temporary dressing (17), the development of the
electric dermatome (18), the establishment of the first U.S. Skin Bank (19),
and the discovery of a cryopreservative agent which allowed the freezing of
tissue in a viable state (20).
In the latter half of the twentieth century,
cadaver skin was employed as a biological dressing in burn patients and
research revealed additional merits of skin grafting (21). In addition to
providing wound coverage, Eade (22) proved that the bacterial count decreased
after graft skin was placed over a wound, and O'Donaghue and Zarem (23)
discovered that skin allografts stimulated neovascularization of the wound bed.
By the early 1970s, cryopreserved skin (24) had been successfully grafted and a
method of in vitro cultivation of epithelial sheets (25) had been developed.
With the advent of cultured epithelial autografts, the problem of allograft
rejections was eliminated, as was the problem of skin donor availability
(26,27). However, cultured epithelial autografts could spontaneously blister
and also took time to produce, typically a couple of weeks. And so the search for
an optimal wound dressing continued.
In 1987, the term 'tissue engineering' was
coined at a National Science Foundation meeting (28). The goal for scientists
now was to create a readily available tissue replacement with the biologic and
pharmacologic properties of human skin (29,30). In 1998, Apligraf, a bilayered
construct of neonatal foreskin fibroblasts, keratinocytes, and bovine collagen,
was the first tissue engineered skin to gain FDA approval (28).
