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Skin Grafts and the First Successful Skin Transplant

It’s the week between the Christmas and New Year Holidays and this blogger is asking herself, what should I be writing about? And if I write it, will anyone even notice because they are doing so many other things like sleeping late into the mornings, visiting with family and friends, cleaning their homes after family and friends have departed, watching lots of movies or sports related activities, etc.?

Inspiration for some of my blog posts often sets in either due to real-time events or a topic that is resonating from the past. The topic for this post is skin grafts. Why? Because one of my close relatives has just undergone this surgical procedure. This week, I learned about a successful skin transplant that was performed by surgeons in France in September 2016 on a victim with burns on 95% of his body. While this historic surgery took place over one year ago, information about the procedure was not released to the media until November 2017.Therefore, the second and related topic of this post is skin transplants.

human-skin

Human Skin (Source: WebMD)

As a reminder, human skin is our largest and fastest growing organ. It is also the outer covering of our bodies. With few exceptions, most of us are born with skin. Human skin has up to seven layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. All too often, we don’t give our skin much consideration until there is a problem like a rash or cut, or it is severely damaged by wounds or burns.

According to Dr. Manny Alvarez of Fox News, “When skin becomes too damaged to heal properly, healthy skin is transplanted to the site by a surgeon. This is called a skin graft. Conditions that may require a skin graft procedure include severe burns, skin ulcers, skin biopsy, surgical wounds or infection.”

Skin grafting is a type of surgery involving the transplantation of skin. The transplanted tissue is called a skin graft. The surgeon will determine if a split-thickness skin graft or a full-thickness skin graft is needed depending on the depth of the area that it needs to cover. After anethesia, the surgeon uses an instrument called a dermatome to remove very thin layers of healthy skin creating a split-thickness skin graft. For full-thickness skin graft, a scapel is used to remove all of the layers of the skin.

After cleaning the area and removing any unhealthy tissue, the surgeon places the skin graft on the wound site requiring stitches to keep it in place. After the procedure the doctor prescribes pain medication and gives instruction on how to clean and take care of the skin as it heals.

skin-graft-and-skin-flap-16-638There are two types of skin grafts, the more common type is where a thin layer is removed from a healthy part of the body (the donor section) like peeling a potato, or a full thickness skin graft, which involves pinching and cutting skin away from the donor section. A full thickness skin graft is more risky, in terms of the body accepting the skin, yet it leaves only a scar line on the donor section, similar to a Cesarean section scar. For full thickness skin grafts, the donor section will often heal much more quickly than the injury and is less painful than a partial thickness skin graft.

Several news sources including BBC News, The Guardian, and IBTimes report that a 33-year-old Frenchman, Franck Dufourmantelle, had an accident at work in September 2016. Engulfed in flames while handling chemicals on the job, Dufourmantelle injuries were extensive and he was expected to die after suffering burns across 95% of his body. When he arrived at hospital doctors said his chance of survival was as low as 1%. However, hopes were raised when they learned that Dufourmantelle had an identical twin brother, Eric.

Eric’s genetic make-up is identical to his brother, Franck.  Transplants from an identical twin eliminate the risk the recipient’s body will reject the donated skin. Franck arrived at hospital in critical condition with deep burns and within a week had received the first skin graft from his twin. He received the grafts from his brother Eric’s head, back and thighs. It was as if it these grafts were his own skin. Experts at the Saint-Louis hospital in Paris undertook about a dozen operations on Franck, taking nearly half of Eric’s skin. Unlike other skin graft patients, Franck required no immunosuppressants.

“It is the first time that such a skin graft has been done between twins for 95% of the body,” said Prof. Maurice Mimoun, a plastic and reparatory surgeon. “It was a virtuous circle. The patient’s skin regenerates faster and faster.” Four months after he was told he was nearly certain to die, Franck was discharged from hospital. [Ref 1]

Franck underwent about 10 graft surgeries during the four-and-a-half months he was in hospital, and was then able to be released to a rehabilitation centre.  The grafts encouraged fresh skin to grow. Normally, skin grafts take place using the skin of a deceased donor, which is typically rejected within weeks. However, this is usually enough time for the patient’s own skin to begin to heal.

According to MedScape [Ref 2], the technique of skin harvesting and transplantation was initially described approximately 2500-3000 years ago with the Hindu Tilemaker Caste, in which skin grafting was used to reconstruct noses that were amputated as a means of judicial punishment.  More modern uses of skin grafting were described in the mid-to-late 19th century, including Reverdin’s use of the pinch graft in 1869; Ollier’s and Thiersch’s uses of the split-thickness graft in 1872 and 1886, respectively; and Wolfe’s and Krause’s use of the full-thickness graft in 1875 and 1893, respectively. Today, skin grafting is commonly used in dermatologic surgery.

IBTimes also reported that in November 2017, doctors in Germany revealed they had successfully fitted a new skin to a seven-year-old boy suffering a rare disease that left his body covered in blisters.

In closing, the technique of skin harvesting and grafting is not new, however, the process and procedures for treating patients continues to improve and evolve.

Sources Cited:

  1. Frenchman survives 95% burns after full-body skin graft from ‘hero’ twin brother, by Paul Wright for the International Business Times, November 24, 2017, http://www.ibtimes.co.uk/frenchman-survives-95-burns-after-full-body-skin-graft-hero-twin-brother-1648742, [last viewed on December 28, 2017]
  2. Skin Grafting, Donald J Grande, MD, author, and Chief Editor, Dirk M Elston, MD, updated June 7, 2017, https://emedicine.medscape.com/article/1129479-overview

 

 

 

 

 

 

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About Vi Brown

Vi is principal and CEO of Prophecy Consulting Group, LLC, an Arizona firm that provides business and engineering services to private and public clients. Prior to establishing her consulting practice in 2001, Vi worked with Motorola, Maricopa County Government, Pacific Gas & Electric, CH2M Hill, and Procter & Gamble. As an adjunct faculty member, Vi teaches undergraduate calculus classes and graduate level environmental courses. She is also a professional speaker.

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