Human skin banking.

Skin autografting was first described by Reverdin in 1871 [1]. The clinical utility of allograft skin as a method for wound coverage followed shortly thereafter [2]. Girdner [3] was the first to report the use of allogeneic skin to cover a burn wound; however, it wasn’t until 5 years later that Thiersch [4] described the histologic anatomy of skin engraftment and later popularized the clinical use of split-thickness skin grafts. In 1874, Thiersch [4] published a report about a small series of patients on whom he later used partial-thickness grafts. Following the report, extensive trials led to cutting the grafts extremely thin to leave some of the surface epithelium behind to heal the donor site. This practice necessitated the use of little, thin chips of grafts, known in the English medical literature as ‘‘Thiersch grafts,’’ ‘‘pinch grafts,’’ ‘‘epidermis grafts,’’ or ‘‘razor grafts’’; these grafts were so generally unsatisfactory for resurfacing large areas that their use was soon restricted to application to small refractory ulcers. Three developments in skin grafting brought about radical advances in the treatment of burn wounds. First, it became apparent that the dermal layer is the most important part of a skin graft in producing a new, tough, resilient surface. Second, it was demonstrated that the donor-site epithelium, after removal of a partial-thickness graft, regenerated from deep islands of hair follicle and sebaceous gland epithelium; thus, grafts could be cut thicker rather than as thin as possible, and the dermis could be transferred without interfering with the healing sites. Finally, because grafts could be cut much thicker, it became feasible to design instruments for cutting larger grafts. These thicker grafts were termed ‘‘split-thickness grafts,’’ and for the first time large areas could be resurfaced satisfactorily in terms of square feet rather than square centimeters.