Wednesday, 13 March 2013

The Tubes and Flaps of Modern Medicine

I'm reading James Le Fanu's account of "The Rise and Fall of Modern Medicine". It's a gripping whistle-stop tour of how medicine changed dramatically from the era of the First World War onwards. Le Fanu pulls out such glorious gems of whimsy in these tales of triumph, I just had to share one here:

In 1973, reports of the first "free skin flap transfer" gave hope that the old style "tube pedicle" transfer -whereby a portion of skin is removed from a healthy area and conjoined to skin that has been damaged (namely from burns) until this skin tube, or bridge, naturally gains a blood supply from the new site, is removed entirely from the healthy area and then sewn as a flap of healthy skin over the damaged area - could become a technique of the past.

The first of the new microsurgical free skin flap transfers involved the complete removal of healthy tissue from an Australian patient's groin area and subsequent transfer to the area of damaged skin on the ankle. This technique made use of the newly-invented operating microscope to enable grafting of miniscule blood vessels between the skin surrounding the damaged site and the healthy skin graft. The tension lay in the skill of the surgeon connecting these pin-head sized vessels, and the question of whether they would immediately carry blood through to the grafted skin.

In this case, they did. And here is the gem:

"After 17 days the sutures were removed and a few luxuriant pubic hairs were noted growing on the ankle."

Le Fanu mined this quote from the original paper in Plastic and Reconstructive Surgery*. It is the appearance of the word "luxuriant" more than "pubic hairs" that really makes me smile. I can imagine authors Daniel Rollin and Ian Taylor enjoyed inserting that into an otherwise standard technical account of an extraordinary technique that transformed the treatment of skin burns.

*Available to subscribers only, sorry.