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Permanent survival of homograft
Permanent
Survival
of Homograft
C. PARKER MEEK, M.D., Aiken, South Carolina tota body surface. The burned areas covered most of both thighs and legs. On January IO, 1953, dhbridement of the burned areas was
OMOGRAFTINGis as oId as the concept of skin grafting. In the earIy part of the present century when the use of free skin
H
FIG. I. Photograph iaken on thirteenth Ieft extremity is homograft. FIG. 2. Photograph
day.211
grafted skin on
taken five months after homotransplantation.
done in the operating room under genera1 anesthesia. On January zznd a spIit-thickness skin graft was done. Four strips of skin taken from the father’s thighs, measuring 3 by 9 inches, were transpIanted to the recipient’s Ieft thigh and leg. These grafts measured approximately .OII-inch in thickness and were taken with a Brown eIectric dermatome. At the same time severa smaIIer spIit-thickness grafts were taken from the patient’s buttock and transpIanted to the right thigh. Subsequent grafts, using onIy the patient’s skin, were done on February 6, March 31, ApriI 22, and June 25, 1953. At the time of the Iast graft a sIiver of skin, which incorporated both the homograft and the patient’s norma skin, was taken for histologic studies. (Figs. I to 4.)
grafts became popuIar the difference between homogenous and autogenous grafts was not appreciated. Grafts of all types were used and successfu1 homotranspIants were reported frequentIy. However, the evidence presented in these claims is not convincing and the onIy proven homograft takes have been in identica1 twins.’ The folIowing case report is on a homograft which at this writing has survived eIeven months and which shows no indication of sIoughing. CASE REPORT H. S., a nine year oId Negro mitted to the Aiken County December 26, 1952, with third covering approximately 32 per
postoperative
boy, was adHospitaI on degree burns cent of the 504
Permanent
FIG. 3. Photomicrograph
SurvivaI
of section of normat skin.
FIG. 4. Photomicrograph
During the course of treatment the patient received three transfusions of the father’s bIood as we11 as bIood from the bIood bank which was given during surgery. The medica treatment consisted mainIy of (2) blood; (3) the following: (I) antibiotics; ascorbic acid; (4) testosterone, IO mg. daiIy for ten days fohowing first graft; (5) kutapressin,@ 35 cc. daily for twenty days foIIowing first graft; (6) muItipIe vitamins daiIy; (7) protein suppIement daiIy; (8) ehxir of benadryI,@ I dr. three times a day beginning on February 6th and continuing unti1 dismissa from hospita1 on JuIy 16th; (9) demeroI@ for acute pain; (10) tetanus antitoxin; (I I) furacin@ dressings to grafted areas; (I 2) aIuminum foi1 dressings to donor sites.* The histoIogic report was as foIIows: “Section of skin some 4 by 0.4 cm. One segment of essentialIy norma structure except for an occasiona focus of sIight perivascuIar chronic inflammatory ceI1 infiItrate (recipient). In the remainder, the epithelium is intact with some areas of atrophy of moderate degree. There is uniform ironing out of the rete pegs, producing * AIuminum foiI furnished by the Reynolds Company, LouisvilIe, Ky.
of Homograft
of section of homograft.
a ffat basa1 zone. These areas are associated with some fibrous reaction in the superficial corium and perivascuIar and periadnexa1 chronic inflammatory infiItrate. There is degeneration of adnexa1 structures; foreign body giant ceI1s are oriented about occasiona hair shafts in which there has been degeneration and disappearance of the foIlicuIar epitheIium.” On Iaboratory examination the urine was negative. HemogIobin was 81.1 per cent. Both the patient and the donor of skin had bIood type 0, Rh positive. White bIood ceIIs and differentia1 were normaJ.
COMMENTS
Between the eIeventh and tweIfth weeks the homograft began to undergo gross changes. The graft Iost some of its pigmentation and began to have a glassy appearance. There was a IittIe sIoughing around the periphery where the donor skin did not touch the patient’s unburned skin. After the bandages were removed and the patient became ambuIatory, much of the pigmentation returned. The Ieft thigh which received the donor skin became
Metals
so5
Permanent SurvivaI of Homograft sIightIy edematous severa weeks postoperativeIy. Much of this edema subsided when eIixir of benadry1 was started. In reviewing the Iiterature on homotranspIantation of skin it was discovered that Caby2 of CorbeiI, France, reported a successfu1 permanent take of a homograft from mother to daughter.
In conclusion, successfu1 homografts possibIe under some conditions.
REFERENCES I. BLOCKER,T. G., JR. and DUKES, C. D. Studies ou 2.
the survival of skin homografts. Plast. Ed Reconstruct. Surg., IO: 248, 1952. CABY, F. SuccessfuI homotransplantation of skin from mother to daughter. Plast. o Reconstruct. Surg., 10: 14, 1952.
ACCORDINGto R. H. Smithwick, excision of the dista1 haIf of the stomach combined with compIete vagotomy in the surgica1 treatment of duodena1 uIcer gives better cIinica1 resuIts than radica1 subtota1 gastrectomy pIus vagotomy. In the Iatter series onIy 64 per cent exhibited persistent achIorhydria, whereas if a Iarger portion of the proxima1 stomach was left and it was combined with a thorough vagotomy, persistent postoperative achIorhydria, after a11 tests, was present in 93 per cent of the patients. In fact, even simpIe gastroenterostomy combined with vagotomy gave superior cIinica1 resuIts to radica1 subtota1 gastrectomy with or without vagotomy. (Richard A. Leonardo, M.D.)
are
Survival
of Homograft
C. PARKER MEEK, M.D., Aiken, South Carolina tota body surface. The burned areas covered most of both thighs and legs. On January IO, 1953, dhbridement of the burned areas was
OMOGRAFTINGis as oId as the concept of skin grafting. In the earIy part of the present century when the use of free skin
H
FIG. I. Photograph iaken on thirteenth Ieft extremity is homograft. FIG. 2. Photograph
day.211
grafted skin on
taken five months after homotransplantation.
done in the operating room under genera1 anesthesia. On January zznd a spIit-thickness skin graft was done. Four strips of skin taken from the father’s thighs, measuring 3 by 9 inches, were transpIanted to the recipient’s Ieft thigh and leg. These grafts measured approximately .OII-inch in thickness and were taken with a Brown eIectric dermatome. At the same time severa smaIIer spIit-thickness grafts were taken from the patient’s buttock and transpIanted to the right thigh. Subsequent grafts, using onIy the patient’s skin, were done on February 6, March 31, ApriI 22, and June 25, 1953. At the time of the Iast graft a sIiver of skin, which incorporated both the homograft and the patient’s norma skin, was taken for histologic studies. (Figs. I to 4.)
grafts became popuIar the difference between homogenous and autogenous grafts was not appreciated. Grafts of all types were used and successfu1 homotranspIants were reported frequentIy. However, the evidence presented in these claims is not convincing and the onIy proven homograft takes have been in identica1 twins.’ The folIowing case report is on a homograft which at this writing has survived eIeven months and which shows no indication of sIoughing. CASE REPORT H. S., a nine year oId Negro mitted to the Aiken County December 26, 1952, with third covering approximately 32 per
postoperative
boy, was adHospitaI on degree burns cent of the 504
Permanent
FIG. 3. Photomicrograph
SurvivaI
of section of normat skin.
FIG. 4. Photomicrograph
During the course of treatment the patient received three transfusions of the father’s bIood as we11 as bIood from the bIood bank which was given during surgery. The medica treatment consisted mainIy of (2) blood; (3) the following: (I) antibiotics; ascorbic acid; (4) testosterone, IO mg. daiIy for ten days fohowing first graft; (5) kutapressin,@ 35 cc. daily for twenty days foIIowing first graft; (6) muItipIe vitamins daiIy; (7) protein suppIement daiIy; (8) ehxir of benadryI,@ I dr. three times a day beginning on February 6th and continuing unti1 dismissa from hospita1 on JuIy 16th; (9) demeroI@ for acute pain; (10) tetanus antitoxin; (I I) furacin@ dressings to grafted areas; (I 2) aIuminum foi1 dressings to donor sites.* The histoIogic report was as foIIows: “Section of skin some 4 by 0.4 cm. One segment of essentialIy norma structure except for an occasiona focus of sIight perivascuIar chronic inflammatory ceI1 infiItrate (recipient). In the remainder, the epithelium is intact with some areas of atrophy of moderate degree. There is uniform ironing out of the rete pegs, producing * AIuminum foiI furnished by the Reynolds Company, LouisvilIe, Ky.
of Homograft
of section of homograft.
a ffat basa1 zone. These areas are associated with some fibrous reaction in the superficial corium and perivascuIar and periadnexa1 chronic inflammatory infiItrate. There is degeneration of adnexa1 structures; foreign body giant ceI1s are oriented about occasiona hair shafts in which there has been degeneration and disappearance of the foIlicuIar epitheIium.” On Iaboratory examination the urine was negative. HemogIobin was 81.1 per cent. Both the patient and the donor of skin had bIood type 0, Rh positive. White bIood ceIIs and differentia1 were normaJ.
COMMENTS
Between the eIeventh and tweIfth weeks the homograft began to undergo gross changes. The graft Iost some of its pigmentation and began to have a glassy appearance. There was a IittIe sIoughing around the periphery where the donor skin did not touch the patient’s unburned skin. After the bandages were removed and the patient became ambuIatory, much of the pigmentation returned. The Ieft thigh which received the donor skin became
Metals
so5
Permanent SurvivaI of Homograft sIightIy edematous severa weeks postoperativeIy. Much of this edema subsided when eIixir of benadry1 was started. In reviewing the Iiterature on homotranspIantation of skin it was discovered that Caby2 of CorbeiI, France, reported a successfu1 permanent take of a homograft from mother to daughter.
In conclusion, successfu1 homografts possibIe under some conditions.
REFERENCES I. BLOCKER,T. G., JR. and DUKES, C. D. Studies ou 2.
the survival of skin homografts. Plast. Ed Reconstruct. Surg., IO: 248, 1952. CABY, F. SuccessfuI homotransplantation of skin from mother to daughter. Plast. o Reconstruct. Surg., 10: 14, 1952.
ACCORDINGto R. H. Smithwick, excision of the dista1 haIf of the stomach combined with compIete vagotomy in the surgica1 treatment of duodena1 uIcer gives better cIinica1 resuIts than radica1 subtota1 gastrectomy pIus vagotomy. In the Iatter series onIy 64 per cent exhibited persistent achIorhydria, whereas if a Iarger portion of the proxima1 stomach was left and it was combined with a thorough vagotomy, persistent postoperative achIorhydria, after a11 tests, was present in 93 per cent of the patients. In fact, even simpIe gastroenterostomy combined with vagotomy gave superior cIinica1 resuIts to radica1 subtota1 gastrectomy with or without vagotomy. (Richard A. Leonardo, M.D.)
are