Reverdin Pinch Grafting Scissors

BAPRAS/738 – Reverdin Example

Date 1870 -1880

What Is This Instrument?

This is an example of the first instrument designed to successfully take a skin graft. 

Swiss surgeon Jacques Louis Reverdin, working in mid 19th century Paris, was struck by the observation of Theodore Billroth that small islands of skin appeared to grow within the granulating wounds of otherwise deep burns. He thus devised an experiment using a lancet and forceps to cut off and transfer small disc-like islands of skin. Removed from one area of good skin, he put them on the same patient’s wound. Demonstrating that he could get these islands to survive, and heal the wound, he presented his work to Societe de Chirugerie de Paris in 1869. The technique was soon demonstrated to be easily repeatable, and useful,  quickly spreading to England. 

The Instrument below (BAPRAS/738) is an early example of combined forcep/scissors, designed to efficiently harvest Reverdin-type skin grafts. Measuring 140mm by 22mm, it was manufactured by Mayer & Meltzer between 1870 and 1880. Presented in a silk lined case, it is currently on exhibition loan to the Hunterian Museum at the Royal College of Surgeons. 

The Collection also possesses another example, BAPRAS/356. Designed in 1872 by surgeon Thomas Bryant of Guy’s Hospital, this instrument, possibly originally nickel plated was manufactrured by Down Bros Ltd in 1950.

What Does It Do?

Both instruments are similar and have two elements. There is a delicate angled pair of forceps sitting just above the closed scissor blades. The scissors are first closely applied,  almost flat, to the skin of the donor site, with the blades open, but pressing down. The forceps are linked such that when the scissors begin closing, they move down, contacting the skin, pushing in a little way whilst simultaneously pinching a little nip of skin. This is then pulled upwards as the blades finally close, cutting, or pinching it off. A little, partial thickness disc of skin results, leaving a small area to heal. The disc of skin can then be transferred to a wound. 

Significance To Plastic Surgery

The technique of pinch grafting effectively solved a hitherto unsolvable wound healing problem, and effectively kick-started modern skin grafting. It was subsequently overtaken by the much more practical and useful, larger area sheet-like Thiersch, or split skin grafts. These instruments are no longer in use. The pinch graft technique itself is is very rarely used today, except it seems by veterinary surgeons.