A new method of grafting
A new method of grafting
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DOI：
10.1136/bmj.1.4301.723
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发表时间：
1943-01-01
影响因子：
--
通讯作者：
Gabarro, P
中科院分区：
文献类型：
--
作者：
Gabarro, P
急诊医院负责整形的外科医生为了理解这种新方法的原理，首先对常用的皮肤移植类型做一个简短的回顾是有用的。根据接枝的厚度，这里将考虑四种类型：(1)薄的Ollier-Thiersch接枝，这种接枝被描述为仅是表皮的（不太准确）；(2)中间或分裂移植物，包含整个表皮和一部分真皮层；(3)较厚的移植约四分之三的皮肤，从汗腺和皮脂腺中留下足够的上皮细胞用于供体区域的上皮形成；(4)全层皮肤，或Wolfe，移植。主要有两个考虑因素调节移植物的选择：移植物越厚，获得的皮肤质量越好；而且移植物越薄，移植就越容易。如果移植物很薄，移植区域应在不到15天内形成上皮。在较厚的移植物中，上皮可能发育迟缓，随后一些疤痕反应可能会破坏该部位，使其无法进一步用作供区。在Wolfe移植中，皮肤完全脱落，必须更换。因此，我们将看到，捐赠地区有其局限性。移植的类型也取决于移植区域的局部条件和患者的一般情况，这不是一件容易决定的事情。当移植面积很大而供体面积有限时，主要问题之一就出现了。当供体面积较小，或患者局部和全身情况较差，且上述移植物均不可取时，通常采用小的圆形移植物，其中有两种类型：薄的或Reverdin移植物，以及由Davies设计的厚的或深的移植物，通常称为“pinch”移植物。两者都是通过相同的技术获得的。后者是英国普遍采用的。
Plastic Surgeon in Charge at an Emnergency Hospital In order that the principles of the new method may be understood it will be useful first to give a short review of the usual types of skin graft. According to the thickness of the graft four types will here be considered:(1) the thin Ollier-Thiersch graft, which has been described-not quite accurately-as only epidermic;(2) the intermediate or split graft, which contains the whole epidermis and a portion of the dermis;(3) a thicker graft of about three-quarters of the skin, which leaves just enough epithelial elements from the sweat and sebaceous glands for the epithelization of the donor area;(4) the whole-thickness skin, or Wolfe, graft.In the main, two considerati6ns regulate the choice of graft: the thicker the graft the better the quality of the skin obtained; and the thinner the graft the easier it" takes." The area from which the graft is taken should epithelize in less than 15 days if the graft is thin. In thick grafts epithelization may be retarded, and subsequently some scar reaction may spoil the site for further use as a donor area. In the Wolfe graft there is a complete loss of skin, which must be replaced. It will be seen, therefore, that the donor area has itslimitations. The kind of graft to be used depends, too, on the local condition of the area to be grafted and on the general condition of the patient, and is not an easy matter to decide upon. One of the chief problems arises when the area to be grafted is very big and the donor area islimited. When the donor area available is small, or the local and general condition of the patient is poor and none of the above-mentioned grafts is considered advisable, use isoften made of small rounded grafts, of which there are two types: the thin or Reverdin graft, and the thick or deep graft devised by Davies and commonly called the" pinch" graft. Both are obtained by the same technique. The latter is the one generally adopted in England.