US 2442435 A
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June 1, 1948. J. D. REESE METHOD OF CUTTING A SKIN GRAFT Filed July 31, 1945 INVENTOR.
Patented June 1, 1948 UNITED STATES PATENT OFFICE METHOD OF CUTTING A SKIN GRAFT John D. Reese, Philadelphia, Pa.
Application July 31, 1945, Serial No. 607,988
This invention relates to skin grafting, more particularly to the cutting of skin grafts from donor areas, and has fOr an object to provide an improved method of cutting such grafts.
In using dermatomes of the so called drum type, comprising a body member having a convex outer surface adapted to be coated with an adhesive for temporary retention of a skin graft thereon, together with a skin-cutting blade mounted for rotation and reciprocation relative to the convex surface for separating the skin graft from the body of the patient while the adhesive convex surface is rolled or rocked on the latter, as fully disclosed in United States Letters Patent No. 2,288,709, granted July '7, 1942, to G. J. Hood and in applicants prior Patent No. 2,366,054, granted December 26, 1944, it is standard practice to coat the convex skin-engaging surface of the dermatome with a suitable adhesive, for example, a rubber cement, and likewise to coat the donor area of the patient with the same type of adhesive.
Under this prior practice, when the convex surface of the dermatome is rolled or rocked on the donor area, the two coats of adhesive cohere to each other and become, in effect, a single layer of adhesive connecting the dermatome surface and the donor area skin. The rolling action of the dermatome on the patients body pulls upwardly on the skin and lifts it away from the body, this lifting force tending to cause failure of the adhesion between the layer of adhesive and the skin, or between the layer of adhesive and the metallic surface of the-dermatome.
Obviously, any such failure of the adhesive connection between the donor area skin and the dermatome results in the cutting of holes in the graft of areas corresponding to the areas over which the adhesive fails.
The frequent failure "of the adhesive used by the profession in the cutting of skin grafts in the manner explained above appears to result from the fact that the adhesive is of such character that if it adheres suitably to the convex metallic surface of the dermatome, then it does not adhere suitably to the human skin, and conversely, if the adhesive is such that it adheres properly to the human skin, it lacks the ability to adhere properly to the metal surface of the dermatome.
Since the drum type of dermatome came on the market several years ago, the profession has cifically, the adhesive applied to the dermatome convex surface would be one selected for its high cohesiveness of adhesion for the particular material of which the dermatome convex surface is made (usually brass) while the adhesive applied to the donor area skin would be one selected for its high cohesiveness of adhesion for human skin.
Regardless of the types of adhesives selected, the two different adhesives will cohere to each other, when the dermatome is rolled on the donor area, more securely than either adhesive will adhere to the particular surface to which it is applied. Thus, the use of the proposed combination of two different adhesives assures of the least possibility of failure of the connection between the demnatome and the donor area skin during cutting of the graft.
Furthermore, it is proposed that the selection of the two adhesives take into consideration the relative cohesiveness of adhesion of the first adhesive to the dermatome surface and of the second adhesive to the donor area skin, it being desirable that the first adhesive adhere more securely to the dermatome than the second adhesive adheres to the graft, so that when the cutting of the graft has been completed, and it is desired to pull the graft from the dermatome convex surface, the adhesion between the skin graft and the adjacent coating of the second adhesive will fail, permitting removal of the skin graft free of all adhesive matter.
Therefore, another object of the invention is to provide, for use in the cutting of skin grafts, a novel method of temporarily retaining the graft on the dermatome.
A further object of the invention is to provide a method of cutting a skin graft, which method will assure separation of the cut graft from the dermatome free of all adhesive material used in cutting the graft.
These and other objects are effected by the invention as will be apparent from the following description and claims, taken in accordance with the accompanying drawing, forming a part of this application, in which:
Fig. 1 is a front elevational view, partiall in section, of a dermatome for use in performing the method of the present invention;
Fig. 2 is a vertical sectional view, taken along the line II-II of Fig. 1, looking in the direction indicated by the arrows, portions of the structure being broken away for the sake of clearness;
Fig. 3 is a vertical sectional View, taken along the line III-III of Fig. 1, looking in the direction indicated by the arrows; and
Fig. 4 is an enlarged, fragmentary view of a portion of the structure shown in Fig. 3.
Referring now to the drawing more in detail, the dermatome, indicated in its entirety by the reference character l0, comprises a drum or body portion l I of semi-cylindrical form, having a pair of spaced side walls I2 and I3, joined alon their curved edges by a concave-convex wall l4,
constituting a skin-engaging 01' graft-receiving face.
A shaft I6 is 'journalcd in a bearing ll'extend ing between, and supported by, the side walls l2 ciding with the axis of generation of the convex surface [8 of the wall I4.
A pair of posts 28 and 2! are supported in par allel spaced-apart relation on the terminal portions of the shaft l6, and carry attheirfree'outer r107 ends 22 and 23, respectively, a knife-holding bar- 24, on which is supported a graft-cutting blade or knife 25, Inasmuch as the space. between the posts 20"and 25 is materiallygreater .than'th'e'i width'of the drum or bod ymember' I l; therectangle formed by the" shaft is, the posts'20 and 2f," 'andthe knife-holding bar 24L -and knife 25' may be reciprocated and rotated as a unit rela t tive to the body member I l. During such move ment; the cutting edge of theknife will'always. be parallel to the convex surface IB'and at a predetermined distance, therefrom, du'e'to the axis of the shaft'lS coinciding with the axis'of generation of the convex surface l8;
It' is believed unnecessarytoLdescribe in' this application, further details of construction of'the dermatome l6, as sufficient structure has already? been explained to enablefithc'selskilled in the art I to understand and appreciate'thenovel features of thepresentinvention, now to be described. -If a more. detailed description of the dermato'me-lfl is desired,-reference may be had to applicants prior Patent No, 2,366,054; granted December 26," 1944. V
In' accordance with the preseht'inventionfthe convex surface l8'of the dermatome l0 iscoated i with an adhesive A (Fig; 4), which adhesive 'hasi a high coefiicient ofladhesion for the articular materialof which the concave-conVex-wall 14' is made.- Usually thismaterialis brass, "and a rubber basecement, for example, running board cement, may be found satisfactory, Runningboard cement-consists of vulcanized rubber dissolved in acids,
Similarly, a coating, of adhesive 7 B is applied to the patients donor area skin S, this second adhesive B having a high coefficient of adhesion for human skin; A 'rubber'base cement, for. example,l artists cement, Jmay be" employed "with satisfactory results. Artists cement consists of raw rubber dissolved in napth'as.
Preferably, twodifferent adhesives A "andrB are. selected. which will result in' the adhesive A adheringdtighte'r. to the dermatome surfacefilB than the adhesive B 'adheresto'the skin Sywith. ,55 the result that when it is sought'toremove' the: cut graft G fromrthe dermatome to' which-it is secured by the coherin'g' coatings of adhesive A and Bfand force is applied to the graftG to pull. it-away from the'dermatome surface [8, the adhesion. between. theadhsive B and-the graft G will fail first -thereby permitting removal of the graft JG free of the coating of adhesive B previouslyapplied thereto, the, coating. of adhesive '3 cohering .to the. coating of adhesive A andvthe latter adhering to the. dermatome.
It maybe. desirable to add coloring matter to the adhesives if they do not'naturally'possess a color clearly distinguishing ,them from the .surfacetoswhich they are to be applied; in order that the .user maybe sure that the coatings of adhesives" completely cover'the desiredareas of the dermatome convex'surface l3 and of the donor area'skin'S.-
While the'invention-ha's been illustrated in '7 4 but one form, it will be obvious to those skilled in the art that it is not so-limited but is susceptible'of various modifications and changes, as well as other applications, without departing from and I 3, the longitudinal axis of the shaft [6 coin-r 5 thesp i t f- What is claimed is:
1. In' a method of cutting a skin graft with a dermatome having a convex skin-engaging surface, the'steps of coating the convex surface with Ia firstzadhesive', and coating 9. section of donor area skin with a second adhesive which will adheretighter to the first adhesive than to the skin and will adhere to the skin less tightly than the first adhesive adheres to the dermatome' convex surface.
2. In a method of cutting a skid-graft witna 1' 'dermatome having a convex skin-engaging'=sur'-. face, the steps of'coating said :derm'atomeconvex surface with -a first adhesivewhichadheres tightly thereto;--and coating-a sectionnof-donor f area skin withfia secondadhesive-which adheres: less tightly tothe skin than the firstedheslve does to the dermatome and than the secondad hesive does to the firstadhesive:
3. In a method ef-cuttinga skin-graftwitlra 1 dermatome having a convex skin-engaging metallic surface, the steps of coating said "convex' i metallic surface with a metal-adhesive cement; and coating a section of-dono'r-area skinwith a human skin-adhesive cement whose coeflicientrf of adhesion for the donor area skin i's lesslth'ani the coefficient of adhesion of the" metal adhesive cement forthe" metallic "convex surfac'e of -the dermatorne.-'
4. In a method of cutting a skin'graft witna dermatome'havinga metallic skin-engaging surface, the steps of coating said metallic surface with -a metal-adhesive "material, -and: coating a donor I areaof skin with 'a human skim-adhesive i material which adheres to the donor area-skin i less firmly than it doesto 'the metal-adhesive material, and less fir'mlythan the lattcr adhercs to the dermatoine metalllc surface.1
5. In a method of cutting a skin graftwvith -a dermato'me having a "convex skin engaging sur-v face, the steps of coating said convex'surface with a first rubber-cement'having -a high coeificient of adhesionfor-the material of Which'fsaidsurface is compcsed, 'and=coatinga donor area of' skin with a second rubbencement having-a lower coefiicient of adhesionfor human skin-"than the first rubber cement has forthe material of which the dermatome convex surface is composed, whereby, when the two rubb'er cements have been caused to cohere 'together by'rocking the coated i convex surface on the "coated donor area skin; and a graftsimultaneouslybut from said donorarea and left adhering to the dermatome convex surface by thetwo cohe'ring cements, pulling of the graft'from-the dermatome will beefi'e'cted byfailure of the adhesion'between the graft'and the second rubber cement, rather than: by failure of the adhesion-between'the first rubber cement and the dermatome'. or-by failure of the cohesion -between the two cement-s;
JOHN D. REESE;
REFERENCES CITED UNITED STATES PATENTS Name Date Hood July 7,1942