II Second Generation: specifically made tools

2. Thiersch’s skin grafting razor: c. 1900,
a solid, straight razor (like the bunion razor)
was designed as a surgical instrument for
more extensive operations when the bistoury,
scalpel or the lancet were too small.
3. Original prototype of the “Blair knife”: with
its protecting holster (Downs, London, 1920).
4. With the development of the disposable
shaving “safety” razor blades the same strips
of sharp steel were used by Bodenham for
skin graft harvesting. Special handles were
made to accommodate these flexible blades.
5. The thin flexible blade were stiffened and
stabilized by a strong back (Thackeray’s
blades) or by solid blade holders (Down’s,
Storz, etc.).
6. A small, freehand dermatome: c. 1980.
7. Sometimes large double hooks were used
to pull and stabilize the skin to facilitate the
harvesting. Another technique was to separate
the skin from the subcutaneous fat and
introduce a metal plate underneath in order
to stabilize it even more. Later a metal or
wooden plate were used to pull and stretch
the skin in front of the advancing dermatome
guard.

8. “Safety” razor: c. 1890, with a guard in front
of a solid razor blade. An ingeniously
designed system in its box allows it to be
sharpened and honed.
9. In 1955 Gullian introduced different guards
to fit the regular preparation, shaving razors.
Each guard allowed harvesting of a giventhickness of skin graft and burn debridement.
10. Other tried to add a guard on a scalpel blade
for the same purpose: c. 1950.
11. Shaving razor disposable blades were used
with a fixed guard for harvesting small
grafts. Two rare left-hand and right-hand
small dermatomes: c. 1950.
12. A double hook and plate: c. 1940, for stretching
the skin for harvesting skin grafts.
13. Similar fixed guards are used in household
instruments (peelers or cheese knives…).
14. Jane Joyant knife modified later after
Humby for Kilner’s use, 1928. (Downs,
London). This is the only existing prototype
of this avant-guard dermatome since its
development was never completed despite
the addition of the adjustable guard. A few
years later, probably inspired by this novel
approach, Humby came with his version of a
guarded, adjustable dermatome that operates
and is controlled by similar means, which was
developed by the same company, Downs
Surgical, London.
15. Humby’s dermatome: 1934, the original
prototype of a solid, not disposable blade.
16. Prototypes of Humby dermatomes for
use with Bodenham (exchangeable,
disposable) blade (Downs, London, 1950).
The sliding blade lock-cover is used in most
dermatomes but can be opened accidentally
by the surgeon during surgery.
17. The Humby-Bodenham dermatome: with
solid forged and reusable blades that were
replaced by disposable blades (Downs, London,
1950).
18. Watson dermatome: This is the most
commonly used hand dermatome mainly
utilized for surgical, tangential excision
of burns. It has a fixed blade guard and a
single regulation mechanism which always
keeps the guard and blade parallel to each
other. The regulation mechanism is situated
on the cutting front (Downs, London, 1960).
This is the standard, currently used manual
dermatome. Unguarded blade corners and
straight long instruments exclude the use of
the dermatome’s ends and limit surgeon
maneuverability in skin folds and in irregular
areas and excisions. 19. Thackray (Campbell)
dermatome: 1970, a similar principle but
different ergonomic design.
20. Chink dermatome: 1950, demonstrates a
slight offset, raised from the surgical plan
handle.
21. See above: Rees and Padgett two Drum
dermatomes: this is the original second
prototype personally donated to Dr. Rosenberg
in 1985 by the son of the inventor, Dr. Earl
Padgett (1893–1946).