Hand scar revision and Split Skin Graft
This is a pencil and ink illustration by Mollie Lentaigne of a procedure undertaken by Archibald McIndoe himself at the Queen Victoria Hospital, East Grinstead on 18th March 1942.
It depicts the revision and reconstruction of a badly scarred hand. Thick scarring, leading to a reduction in hand mobility and function, as well as being uncomfortable and unsightly, is a common complication of deep burns. In this case the surgeon, Archibald McIndoe, incises around the area of scar, paring back to remove it. This is performed at a depth which removes scar, but leaves sufficiently blood supplied tissues to support and heal a skin graft. The Split Skin Graft (also known as a Thiersch graft) is shown being taken from a common donor site, on the thigh. It is being taken by a hand knife common at the time, and in contrast to the Drum Dermatome method depicted here. The wooden board run in front of the knife tenses and flattens the skin, permitting the graft to be shaved. The graft would then be draped over the raw wound and attached to it using catgut sutures.
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.