Plastic surgery; its principles and practice . it. and the scarbecomes more resistant as the tension is relieved. In whole-thickness grafts it is important to choose the skin to betransplanted with some regard to the type of skin which will surroundit. For instance, it is best where transplantation to a hairless part ofthe face is proposed, to select the inner forepart of the upper arm, asit is thin and practically without hair. As the success of the graft depends on the blood supply of its newbed, it follows that it should not be placed on denuded cartilage (with- 88 PLASTIC SURGERY out peric
Plastic surgery; its principles and practice . it. and the scarbecomes more resistant as the tension is relieved. In whole-thickness grafts it is important to choose the skin to betransplanted with some regard to the type of skin which will surroundit. For instance, it is best where transplantation to a hairless part ofthe face is proposed, to select the inner forepart of the upper arm, asit is thin and practically without hair. As the success of the graft depends on the blood supply of its newbed, it follows that it should not be placed on denuded cartilage (with- 88 PLASTIC SURGERY out perichondrium) or be used for bridging over defects. Pedunculatedflaps should be used for this purpose. However, grafts can be success-fully placed on healthy tendons, fascia, muscle, cortical and spongybone, periosteum, and on the dura mater. The Ollier-Thiersch method will, of course, remain the method ofchoice on account of its simplicity and smaller operative action, but insuch exposed localities as the elbow, palm of the hand, knee, or heel,. Pig. 96.—Result of whole-thickness grafting for the relief of a contracture of the palmand fingers following a burn from electricity. Photograph taken eighteen months aftergrafting. where there is a good deal of pressure and friction, these thin graftswill not stand the strain. It is advisable to use large whole-thickness grafts, as the healingand adhesion is as good as with small ones, and there are fewer scarsand, therefore, less likehhood of future contracture. Extraordinary results have been obtained from the use of whole-thickness grafts in most unfavorable cases, and this type of graft shouldbe more generally utilized. THE TRANSPLANTATION OF SKIN 89 It is of course, always wise to graft a suitable defect in the skinimmediately after an operation, but should a granulating wound bepresented we have to decide whether it is best to graft on the untouchedgranulations, or whether the granulating wound should be made a freshone by the rem
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