In 1941 the British immunologist Peter Medawar published a study in Nature looking at skin grafting – one of the first researchers to investigate the technical difficulties posed by producing “Sheets of Pure Epidermal Epithelium from Human Skin”, the title of his paper. The problems of successful skin grafting became important because of the number of badly injured soldiers and severely burned airmen returning home from the Second World War.
Three years later, in 1944, Medawar, then a zoologist at Oxford University, wrote a report to the War Wounds Committee of the Medical Research Council on The Behaviour and Fate of Skin Autografts and Skin Homografts in Rabbits. “The repair of injuries involving an extensive loss of skin has long been recognised to be a surgical problem; one for which, in the majority of cases, the operation of skin grafting is a fully adequate solution,” he reported.
Autografting is when skin is taken from one site of the body to another, while a homograft (or allograft) involves transplanting a skin from a donor to a recipient. Medawar was trying to work out why homografting fails while autografting succeeds. It was his seminal work on tissue rejection resulting from work on skin grafts that later developed into his discovery of acquired immunological tolerance, for which he shared the 1960 Nobel Prize.
In his 1944 report to the War Wounds Committee, Medawar explained why skin grafts in rabbits were so invaluable in research. “Skin is the tissue of choice, because it can be made to provide a quantitative measure of the time of survival of foreign tissue under a variety of different conditions, and because like nerve and bone (but unlike glandular tissue) it can be grafted ‘isotopically’ – into an anatomically natural environment,” he wrote.
Today, skin autografts are used routinely in plastic surgery, where healthy skin is removed from an unaffected area of the body and transferred to the area needing surgical improvement. They are used for bone fractures that break the skin, large wounds or for problems such as cancer and burns. A full-thickness skin graft involves the transfer of the top layer (the epidermis) and all layers of the skin underneath (the dermis), and the area is then closed with stitches – only a small area is removed. A partial or split-thickness skin graft involves the removal of the epidermis and a small part of the dermis, usually from the thigh, buttock or upper arm.