Giuseppe Baronio And The Origins Of Free Skin Grafting
The publication of “Degli Innesti Animali” (On grafting in Animals) by Giuseppe Baronio (1759-1811) in 1804, the first account of experimental autologous skin transplantation in a ram, marks the beginning of a new era for plastic surgery - the demonstration that skin transfer in the same individual is possible and successful.
Giuseppe Baronio — His life and contributions
Giuseppe Baronio was born in Milan (Northern Italy) in 1759. He studied Medicine at Pavia University, a historical city 20 miles south of Milan, as Milan had no University at that time. One of his teachers was Lazzaro Spallanzani (1729-99), Professor of Natural History, well known for his studies on regeneration and reproduction of animal parts. In 1780, Baronio graduated in Medicine and Philosophy with a thesis on regeneration of limbs in warm and cold-blooded animals and this may have had an influence on his future researches. The following year he became an intern physician at Ospedale Maggiore of Milan. Due to his lack of interest in politics and particularly for the French government, which was dominating Milan in that period, he did not advance in his career. Although he tried numerous times to obtain a better position, he never succeeded. His applications were constantly rejected. The only duty he could obtain was an appointment as Physician of the Prisons.
In 1807, he was affected by gout and his physical conditions deteriorated slowly. The following year he could have had the opportunity to apply for a professorship in physics at Bologna University, but he was advised by some of his friends and colleagues against submitting the application, due to his poor health. Three years later, in 1811, Baronio died aged 52, completely forgotten. He never married.
Baronio had numerous scientific interests and published his observations extensively. His works were recognized for their scientific value, so it was possible for him to become a member of various scientific societies. He wrote on the treatment of rabid dog bites, on the regeneration of bone and brain in fowl, on the regeneration of the Achilles tendon in the human being, on the superiority of the San Pellegrino spring waters, on electricity. He was a close friend of Alessandro Volta (1745- 1827), Professor of Natural Philosophy at Pavia University, with whom he conducted some experiments on electrical phenomena. He described a new galvanic pile composed of vegetable materials only, capable of producing contractions in a frog.
Degli Innesti Animali
Degli Innesti Animali, the most important work of Baronio, is a 78-page book, printed on thick paper, issued in 1804 in Milan by Tipografia del Genio (fig.1). The book is rare and seldom appears on the market. It is divided into seven parts and includes three engraved illustrations. The first one shows the portrait of the Count Carlo Anguissola, to whom the work is dedicated, who sponsored the publication, although this is not mentioned, and provided animals and stables for making Baronio’s experiments possible.
In parts one and two, Baronio traces the origin of nasal reconstruction by quoting the Brancas of Sicily, Tagliacozzi, and the Maratha surgeons from India. The Tagliacozzi’s arm flap technique is extensively described, whereas the Indian forehead flap procedure is also illustrated by an engraved plate. Part three is devoted to transplantation of teeth in human beings, a procedure first reported by John Hunter; whereas part four explains the grafting of spur and “other animal parts into the cock’s comb.” In part five, Baronio reports the method of healing severed skin parts by using certain balms, as proposed by some charlatans. Part six, the most important section of the book, deals with the original Baronio studies on skin graft in a ram. He carried out three types of experiments on the farm of the estate of the Count Anguissola at Albignano, in the surroundings of Milan (fig. 2, 3). In doing this, Baronio was supported by two Milanese surgeons G.B. Monteggia (1762-1815) and G.B. Palletta (1748-1832).
In the first experiment, he excised a piece of skin from the dorsum of a ram and grafted it immediately on the opposite side without suturing it, but attaching it with an adhesive. After eight days the graft took perfectly. In the second experiment, on the same ram, the time lapse was 18 minutes. Baronio noticed that the graft had some difficulties in taking (Author’s note: probably superficial necrosis at it occurs in full thickness skin grafts). In the third experiment, always on the same ram, the time lapse was longer and the graft did not take. He concluded that the shorter the time for transplantation the better in terms of survival rate. A beautiful engraved illustration of a ram with skin grafts positioned along its dorsum accompanies the text (fig. 4). Regrettably, Baronio was not aware that the thickness of the skin was the most important factor for skin graft survival. Very possibly in the third experiment he harvested the skin with the underlying adipose tissue, thus jeopardizing the graft take.
In the last part of the book, part seven, he created wounds on different animals (goat, dog, sheep) and covered them with aluminum paste to isolate wounds from the air to avoid potential contamination. He noticed that this method facilitated wound healing.
How did Baronio come to this great idea? In explaining the rationale for his investigations, he affirms “I want to verify tissue regeneration and healing process in wounds.” Certainly a legacy of the period he spent at Pavia University with his teacher Lazzaro Spallanzani, who dedicated an entire life to studying regeneration and reproduction of animal parts.
Degli Innesti Animali was translated into German in 1819, but despite this it had little impact on followers. The work was almost completely ignored and seldom quoted. We have to be grateful to Robert Goldwyn who translated it into English, making the text available to the plastic surgery scientific community.2 Other surgeons like Johann Friedrich Dieffenbach (1794-1847), Alfred Armand Velpeau (1795-1867) and the French physiologist Paul Bert (1833-1886) tried to reproduce the skin grafting technique. Paul Bert in particular repeated some of Baronio’s experiments 59 years later and described them in his doctoral thesis, published in 1863.3
However, most of these authors reported a high rate of failure. Transfer of a full-thickness piece of skin, more difficult to be revascularized, instead of a split thickness piece of skin was probably the explanation. Another negative factor in skin grafts taking was infection.
In 1869, sixty-five years after the publication of Degli Innesti Animali, for the first time in the history of surgery, the Swiss-born surgeon Jacques Louis Reverdin (1842-1929) obtained healing of large open wound in man by transplanting thin and small portions of autologous skin from a healthy area of the same individual. The operation was performed at Hôpital Necker in Paris.4 Other pioneer surgeons like Pollock, Lawson, Ollier, Thiersch and Wolfe used the skin grafting technique and improved it, so that it became the solution of choice for covering chronic and granulating defects.
Degli Innesti Animali, has to be considered an epoch-marking work for several reasons. It is the only treatise on plastic surgery written two centuries after Tagliacozzi’s De Curtorum Chirurgia (1597). It is the first experimental account on a successful autologous skin graft in an animal with a detailed report. It is the first example of purely scientific research in the history of plastic surgery. For this reason, the founding members of the Plastic Surgery Research Council established the image of the Baronio ram with skin graft over its dorsum as the emblem of the organization.
- Baronio G. Degli Innesti Animali. Stamperia e Fonderia del Genio, Milano 1804
- Baronio G. On grafting in Animals. Translated by J.B. Sax with an historical introduction by R.M. Goldwyn. Boston Medical Library, Boston 1985
- Bert P. De la Greffe Animale. Imprimerie Martinet, Paris 1863
- Reverdin JL. Greffe épidermique. Expérience faite dans le service de M. le Docteur Guyon, à l´Hôpital Necker. Bull Soc imp Chir Paris 1869; 10: 511- 15
Riccardo F. Mazzola, MD – Italy