Drum Dermatome Skin Graft Harvest

This is a pencil, ink and watercolour illustration by Mollie Lentaigne of a procedure undertaken at the Queen Victoria Hospital, East Grinstead during World War 2.

It shows a split thickness skin graft (also known as a Thiersch graft) being harvested from a common donor site on the right leg. It is being harvested using a Padgett Drum Dermatome, popular at the time. However, hand knives were much more common for this purpose, as depicted here. A rubber solution adhesive is applied to the curved drum portion of the device, which is then stuck to the skin of the donor site. As the drum is pulled back and rotated, a reciprocating blade was used to harvest the sheet of skin graft at a precise depth.

In this case the skin graft is being used to resurface an extensive wound on the back of the right hand, probably following excision of a contracted burn scar.After draping over the wound and suturing to the hand using catgut, the graft has been perforated to create drainage holes. This is an early form of graft “meshing”, intended to allow excess fluids to drain from under the graft. Even tiny collections of fluid would prevent graft healing or “taking”.

Lentaigne’s illustrations are often more diagrammatic, and perhaps more informative than by comparison to some of her peers. She usually sketched quickly in theatre, dodging around the surgeons in order to see what they were doing. Later, she would have gone back over the lines, enhancing the drawing using inks and watercolour before adding annotations. This would have both formed part of the patient’s operative record and acted as a teaching resource for other surgeons.

This illustration is reproduced by kind permission of the East Grinstead Museum who hold the complete archive of Mollie Lentaigne’s works at the Queen Victoria Hospital.