A Narrative Review of the History of Skin Grafting in Burn Care

Abstract

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.

A Narrative Review of the History of Burn-Related Depression and Stress Reactions

“…Religious ideology made way for natural philosophy and deductive reasoning. With regard to burn care, Ambroise Paré (1510–1590) brought the first advancement in empirical thinking in 1535, when he ran out of boiling oil, the standard treatment of burn care, while on a military campaign for Napoleon and was forced to use a balm of egg yolks, rose oil and turpentine [ 47 ]. Taking advantage of his impromptu natural experiment, Paré noted that those treated with the balm experienced better outcomes and subsequently adjusted his treatment protocols.…”

Skin Substitutes and Biologic Agents for Wound Closures after Melanoma Resection

“…Biological wound agents have advanced the reconstructive ladder since they were originally created in the late 20th century and are now used to repair abnormalities in the skin, soft tissue, and bone [4][5][6]. The classification of biologic wound care products used in skin and soft tissue restoration, as well as benefits and drawbacks of their application, will be covered in this chapter.…”

Evaluation of Magnesium-Phosphate Particle Incorporation into Co-Electrospun Chitosan-Elastin Membranes for Skin Wound Healing

“…Standard treatments for severe burns use auto-, allo-, or xeno- grafts [ 5 , 6 ]. These treatments rely on explanted skin tissue covering damaged tissue and acting as a platform for new tissue growth.…”

“…These treatments rely on explanted skin tissue covering damaged tissue and acting as a platform for new tissue growth. Skin grafts provide the damaged environment with protection, a structural template, and biological cues for healing and regeneration [ 6 ]. However, these treatments are still exposed to the external environment and are prone to infection [ 7 ].…”