NewThe Purist Q is open. Ten questions on the anatomy of skin, free.Try it
AnatomyM8
The Purist QNew

Series 1: The Skin · Episode 10, not yet released

Skin Grafts Part One

The Biology of Take

26 minutes. 19 references, each checked at source.

Follow the podcast
Listen on SpotifyListen on Apple Podcasts

The Suśruta Saṃhitā describes rebuilding a nose with a flap from the **cheek**, not the forehead. The Sanskrit is *gaṇḍapārśva*, "the side of the cheek", at Sūtrasthāna 16.28, and the word for forehead never appears in the passage. The forehead flap belongs to a later hereditary tradition of potters and brickmakers, and reached Europe in 1794 through the Cowasjee case near Poona.

Episode 10 of The Anatomy Purist, Series One: The Skin. Dev opens with that correction, including why the forehead attribution survives in peer-reviewed journals that never quote the verse, why "600 BC" is a traditional attribution rather than a scholarly date, and why there is no gluteal free graft in the Samhita at all. Then: the phases of skin graft take, and why the published timings disagree with each other. Primary versus secondary contraction, stated in the direction that survives scrutiny. Split versus full-thickness graft properties, with the thickness figures, and what each does to pigmentation and hair. Recipient bed requirements, including the cancellous-yes, cortical-no distinction. Decortication, which is not the Papineau technique. And the anatomy behind every cause of graft failure, inc

Themes from this episode

Practice what you just heard

Two questions on the themes of this episode, free, marked as you go. Then one from the Vault on the same ground.

Question 1 · Applied

What is the principal advantage of mesh grafting over sheet grafting?

Answer to see the explanation and the source.

Question 2 · Foundation

What tissue is included in a split-thickness skin graft?

Answer to see the explanation and the source.

From the Vault, on the same theme

General Principles: Vascular, Lymphatic & Metameric Organisation · Purist Locked

In experimental animals, stripping the adventitia from a large elastic artery is followed by necrosis of the outer media, while the inner part of the wall remains healthy. What does the experiment demonstrate?

  • AThe media has an intrinsic capillary bed entering from the luminal surface at intervals
  • BThe adventitia itself elaborates the nutrients on which the media depends
  • CSympathetic fibres in the adventitia maintain the metabolic viability of medial muscle
  • DThe outer media drains its wastes through adventitial lymphatics, whose loss poisons it
  • EBeyond a critical depth the wall outruns luminal diffusion and needs vessels of its own

Unlock to see the answer

Unlock the Vault, £49
Try ten free questions from the seriesWhat the Vault is

References

  1. Kohlhauser M, Luze H, Nischwitz SP, Kamolz LP. Historical evolution of skin grafting, a journey through time. Medicina (Kaunas). 2021;57(4):348. PMID: 33916337.
  2. Reverdin JL. Greffe épidermique. Bull Soc Imp Chir Paris. 1869;10. *(Pre-index; pagination is cited variably in the secondary literature and has not been verified against the original volume, cited here without page numbers for that reason.)*
  3. Converse JM, Uhlschmid GK, Ballantyne DL. "Plasmatic circulation" in skin grafts. The phase of serum imbibition. Plast Reconstr Surg. 1969;43(5):495-9. PMID: 4889411.
  4. Clemmesen T. The early circulation in split-skin grafts. Restoration of blood supply to split-skin autografts. Acta Chir Scand. 1964;127:1-8. PMID: 14104702.
  5. Greenwood J, Amjadi M, Dearman B, Mackie I. Real-time demonstration of split skin graft inosculation and Integra dermal matrix neovascularization using confocal laser scanning microscopy. Eplasty. 2009;9:e33. PMID: 19787028.
  6. Rudolph R. Contraction and the control of contraction. World J Surg. 1980;4(3):279-87. PMID: 6998140.
  7. Robson MC, Krizek TJ. Predicting skin graft survival. J Trauma. 1973;13(3):213-7. PMID: 4571903.
  8. Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev. 2001;14(2):244-69. PMID: 11292638.
  9. Papineau LJ, Alfageme A, Dalcourt JP, Pilon L. [Chronic osteomyelitis: open excision and grafting after saucerization] [in French]. Int Orthop. 1979;3(3):165-76. PMID: 393639.
  10. Ratner D. Skin grafting. From here to there. Dermatol Clin. 1998;16(1):75-90. PMID: 9460579.
  11. Split-thickness skin grafts. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf ID NBK551561.
  12. Full-thickness skin grafts. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf ID NBK532875.
  13. Standring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier; 2020. Ch. 7, Skin and its appendages.
  14. Meulenbeld GJ. A History of Indian Medical Literature. Vol. IA. Groningen: Egbert Forsten; 1999. p. 203, 357.
  15. Wujastyk D. The Roots of Ayurveda. 3rd ed. London: Penguin; 2003. p. 63, 65.
  16. Bhishagratna KKL, trans. An English Translation of the Sushruta Samhita, Based on Original Sanskrit Text. Vol. 1: Sutrasthanam. Calcutta: published by the author; 1907. Ch. XVI (Sūtrasthāna 16.28), donor site rendered as the cheek.
  17. Saraf S. Sushruta: rhinoplasty in 600 B.C. Internet J Plast Surg. 2007;3(2). *(Independent English rendering of Sūtrasthāna 16; donor site given as the cheek. Volume and issue numbering not verified against the publisher's record, see fact-check notes.)*
  18. [Anonymous correspondent.] A singular operation. Gentleman's Magazine. 1794;64. *(The Cowasjee account, transmitted by East India Company surgeons near Poona. Pagination not verified against the original volume.)*
  19. Carpue JC. An Account of Two Successful Operations for Restoring a Lost Nose from the Integuments of the Forehead. London: Longman, Hurst, Rees, Orme and Brown; 1816.
Episode 9: When Skin FailsEpisode 11: Skin Grafts Part Two
All episodes

Before you go

Tell us how this one landed

What worked, what you had to replay, and what you would like covered next. Requests are the main way the running order gets decided.

Send feedbackReport an error in this episode