Medicine: Spreading the Graft

For anybody as badly burned as Albert Padgett, the prospect was grim: he could expect to spend many months in the hospital, much of the time in such severe pain that he would have to be kept in bed on opiates. For Padgett, 28, a day laborer, had 50% to 60% of his body burned (most of it with third-degree severity) in a gasoline explosion and fire in mid-September. But within six weeks, Padgett was up and about and bathing himself. Last week he walked out of Aiken (S.C.) County Hospital, was due back at work within two months.

Two-Way Slice. Padgett's accelerated recovery, to Aiken's Dr. C. Parker Meek, showed the value of an ingenious modification Meek has made in skin-grafting technique. The underlying method is not new. Called microdermagrafting, it is based on the fact that pieces of skin, grafted from one part of the patient's body to another, tend to grow outward from the edges and cover more than their own original area. This is vitally important for patients with little unburned area left to provide skin suitable for grafting. But the surgeon usually has to transplant scores of tiny pieces of skin by hand.

Dr. Meek, no specialist in plastic surgery but a country doctor with a deep humanitarian interest in burn victims, sought a quick, simple way to cut skin into minuscule patches, then a way to get them in place promptly and efficiently. For the first, working with a machinist patient, he devised a precision slicing machine. Dr. Meek cuts a thin patch of skin, 12 in. square, from the patient. He puts it on a cork pad to hold it steady and with two runs of the machine, made at right angles, cuts it into 225 pieces of skin, each 1½ in. square. Whereas the original patch had 6 in. of periphery to grow out, the 225 miniature patches have 90 in.

Two-Way Stretch. The payoff is in the rayon dressing to which Dr. Meek transfers the cut, but still unseparated, patches. Its center is only 1½ in. square, but it has been pleated in both directions. With the outer surface of the skin held to this pleated square by a special adhesive, Dr. Meek simply stretches the dressing, first in one direction, then the other, so that it comes unpleated. As it unfolds flat, the 1½-in. square becomes a 4½-in. square, with the tiny skin patches spaced 2/10 in. apart in each direction. The whole sheet is used as a graft, covers nine times the area of the 1½-in. square.

After the graft grows out there is sometimes a "cobblestone" effect in the patient's skin. But Dr. Meek contends that this is a minor matter compared with his saving of time and pain, and reduced risk of drug addiction.