SKIN GRAFTING FOR MALIGNANCY OF THE ORBIT. 
By FLAVEL B. TIFFANY, M D., Kansas City, Mo. 
Bead before the North Texas Medical Association, at Sherman, Texas, June 20tli, 
1894, in the Section of Surgery, by J. T. Wilson, M. 1)., 
Chairman of Section on Surgery. 
The following is an abstract from a report of a case wherein skin 
grafting was resorted to as a therapeutic agent in malignant growths, 
published in the St. Louis Medical Journal, September, 1882; with 
illustrations and other data. 
It was as an effort to smother out malignant growths that contin- 
ued in their persistency to spring up from the empty orbit after exen- 
teration of the eye-ball which was enmassed by an epithelioma. The 
Fig. 1. 
Fig. 2. 
patient was a negro, Richard McGee of Galena, Kan., aged 58 years. 
The tumor originated at the margin of the inferior lid of the right eye, 
hut when the patient visited me, February 7th, 1882, it had extended 
to the eye-ball, to the superior lid and to the cellular tissue of the 
orbit. The growth was about the size of an Osage orange and com- 
pletely covered the globe. (Fig. 1.) 2 
Upon removing the tumor the eye was found to be cataractuous. 
From this and the fact that the tumor had involved both lids and the 
surrounding tissue, it was thought advisable to remove the eye-ball. 
After sweeping away the tumor, lids and eye-ball with the soft tissues 
of the orbit, the parts were thoroughly cauterized with the thermo- 
cautery, completely cremating everything down to the periosteum. 
Hemorrhage was profuse and in order to check this the cavity was 
packed with lint saturated with sulphate of iron. This packing was 
left several days and after its removal the orbit was dressed by a car- 
bolized wash; but in a short time several cauliflower growths sprang 
from the sides and near the apex of the orbit and grew with 
rapidity. These were removed by the scissors and the surface seared 
Fig'. 3. 
or cremated with Paquelin thermo-cautery, but still the growths per- 
sisted and as fast as they were cut away or destroyed they would 
return, until I resorted to skin grafts taken from the chest of the 
patient. These grafts were large, measuring some more than one-half 
an inch in width and three-quarters of an inch in length. They were 
of the true skin and conveyed without handling to the raw and gran- 
ular surface of the diseased orbit. There was no difficulty in getting 
the large grafts to live, excepting at one point, beneath the arch of 
the brow. (Fig. 2.) Over the site of the funguous growth the grafts 
grew with even greater avidity than elsewhere. The spot beneath the 
brow remained for a long time an open, indolent, raw surface, until 
finally the grafts were made to adhere. The grafts placed over the site of the morbid growths were destroyed from time to time by the 
action of the zinc used, but new grafts, large though they were, suc- 
cessfully took root and grew, all the time recovering ground from the 
fungus growths until the bulk of the latter being removed the healthy 
cell life of such portions of the growth as escaped the scissors and 
zinc, converted as it were the malignant into the benign, smothering 
the morbid tendency and hastening the process of repair. After six 
Fig. 4. 
months treatment the wound was completely healed. (Fig. 3.) This 
patient was still living a year and a half ago when I received a letter 
from him written at Oklahoma City, and there had been no return of 
the tumor. 
At the time I operated there had been no account of such large skin 
grafts used, and in no instance had they been employed for the pur- 
pose of subduing malignancy. This accidental use of the skin-graft 4 
in malignant tumors with the results, showed that the potentiality for 
good in a few healthy living cells was even greater than that of an 
army of malignant ones for evil. It was like introducing a few good, 
law-abiding citizens into a gang of thieves and outlaws, where the few 
rule and peace and order is gained. Believing then as I had reason 
to, that I had made a discovery by which malignant cells could be 
controlled by a few healthy ones, I did not stop with this one case, 
but have repeatedly resorted to skin grafting in malignancy of the lids 
and orbits in cases which have since come to me. It has now been 
Fig. 5. 
Fig. 6. 
about a year since I operated, assisted by my colleagues Drs. Bogie 
and Herrieford of Kansas City, upon a prominent physician in this 
city for malignant growth of the nose and lid near the inner canthus. 
Here I transplanted a circular piece of skin as large as a silver quarter 
from the arm of the patient. There was no sloughing of the graft, 
and to-day the parts are smooth and the scar is scarcely noticeable. 
Some two years and a half ago I operated upon a prominent citizen of 
Emporia, Kan., for cancer of the upper lid. (Fig. 4.) The growth 
was of several years standing and had involved almost the entire lid, 
so that I was compelled to remove nearly all of the integument of the 
lid. The plant taken from the forearm of the patient was cut at least 
one-third larger than the bed on which it was to lie. The man now 5 
has a perfect lid with scarcely any scar, and there is no tendency of 
the tumor to return. (Fig. 5 was taken three days and Fig. 6 three 
weeks subsequent to the operation.) 
In making these plastic operations the most scrupulous sanitation 
Fig. 7. 
is adhered to. I first see that the patient is in as good general health 
as possible and then with scrupulous cleanliness I transfer the grafts. 
I first scrub the surface of the malignant parts with soap and water. 
Afterwards with a solution of bi-chloride of mercury, 1 to 1000. The 6 
parts from which the graft is to be taken are also subjected to a thorough 
cleansing with soap and water, and then bathed with antiseptic solu- 
tion. The malignant growth is removed, its bed or seat measured 
and a corresponding measurement outlined upon the arm or chest 
Fig. 8. 
from whence the graft is to be taken, and then the graft is cut about 
one-third larger than the dimensions of the cavity to be filled. It is 
transferred without handling immediately to its new abode where it 
is fixed in position by a few stitches of delicate silk, which has been 7 
passed through bi-chloride solution. In resorting to these grafts I 
frequently take very large plants. In my last case, where I operated 
for ectropion (Fig. 7), caused by a burn, I took a graft, one and a half 
inches wide by three inches in length. (Fig. 8 was taken three days 
Fig. 9. 
and Fig. 9 three weeks subsequent to the operation.) I excise the true 
skin down to the areolar tissue, taking care not to include any adipose 
or connective tissue. I am also careful to staunch all hemorrhage 
before transferring the plant. After attaching the graft by delicate silk sutures I dust on dry calomel powder, cover with gauze and fasten 
with adhesive straps. I do not disturb the dressing for several days, 
not until it is time to remove the sutures. Circulation is usually 
established by the second day. At first the piece is cadaverous in 
appearance, but soon it grows red or takes on the color of the natural 
skin, occasionally it turns black but does not slough. 
It frequently exfoliates, especially if it needs to be thinned, but 
nature takes care of that, moulding, shaping and coloring it to suit 
her need and taste. In none of the cases where I have resorted to 
skin grafting for cancer has there been any return of the malignancy. 
When I first introduced this discovery, my professional brethren 
were disposed to make light of it, and treat it with incredulity. I 
recall one gentleman saying that he thought that placing the grafts in 
this mass of diseased tissue would be like throwing a sound, healthy 
apple into a barrel of rotten ones that the good ones would slump away 
with the rest. But not so, it is rather like grafting a healthy bud into 
a nearly sour apple tree and getting most excellent fruit; or, as I said 
before, it might be likened unto placing a few good law-abiding citi- 
zens among a gang of outlaws; by the few, law and order would soon 
be gained.