Grafts and transplants

Abstract

The transplanting of tissues as grafts as well as where replacement may be expected plays an important part in the operative procedures of today. The surgeon, however, should discriminate in his conversation and writings between the terms “transplant” and “graft,” for as we have seen, they are not synonymous words and, as educated men we should use correct English. A graft is an immediate transplantation of tissue which continues to live and grow in its new environment. For a graft to be successful, the cells of the transplanted tissue must obtain nutritious lymph during the period of healing. The only tissues that have been found to be successful for grafting, because of their structure, are those of the vegetative type, that is those which have no intrinsic blood supply. Tissues which contain intrinsic blood supplies are not suitable as grafts, as the circulation of blood within them becomes interrupted during the act of transplantation and, before it can be reestablished, the cells die for lack of nourishment and all that remains is the stroma of the tissue. This, however, may be revascularized from the tissue surrounding the transplant and is resorbed and often replaced by tissue of identical structure. The transplantation of tissue of this type is a useful procedure to supply losses, but it must not be confused with the act of grafting nor should such a transplant be called a graft. Transplants of any tissue should, if possible, be autogenous in type, that is composed of tissue from the same individual. If foreign tissue is transplanted in the body of an individual it produces, through its irritating action, a leucocytic and fibroblastic reaction in the tissue of the host, which may result in the total destruction and absorption of the transplant and its replacement with fibrous tissue, or its extrusion from the wound. Experience has demonstrated that heterogenous and homologous grafting results in failure.