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@skylarynn

Ah, my mistake! I didn’t see the second follow up question. Or maybe I did and I just forgot about it. Thank you for asking again!

A warning in advance – this is some gruesome material. In a nominally related tangent, the Russian word for hospital, Больница (Ballnitza) literally means “house of pain.”

Regarding medieval skin grafts… the bulk of the information we have available regards rhinoplasty, or nose jobs. Not for vanity, no – until the invention of antibiotics, syphilis was the bane of those who couldn’t keep it in their pants, or who made a living of getting in others’. One of the long term consequences of syphilis are its characteristic sores, blisters, and massive disfigurement – one of the most prominent and inevitable symptoms being the infamous “saddle nose” in which the bridge of the nose necrotized and rotted away, leaving you with a bad case of Voldemort face. Those who could afford it would pay for surgery by a (hopefully) competent surgeon, for which there were two methods: the Italian method, perfected by Gaspare Tagliacozzi in the mid-late 1500s (he died in 1599, and his technique fell out of use with him), and the Indian (Hindu) Method, brought to Europe during Antiquity (Rome), and practiced since 600 BC.

The Indian Method consisted of slicing free a full-thickness section of skin from the forehead, twisting it down and around where the nose used to be, and shaping it into a new nose around a wax mold (which you would obviously remove once the nose was fastened in place). It would take 14 days for the graft to take, and then another 25 days or so for full healing (including the donor site). It worked remarkably well – if neither donor site nor your new nose got infected, you would heal with an at least passably human nose, although you would have a strange unpigmented triangle on your forehead where your new nose came from (mixture of new skin and scar tissue – tends not to come with melanin). Infection rates also seem to have been pretty low (granted, being rich enough to afford a surgeon also usually means you’re generally cleaner), although some surgeons were dogged by graft rejections – which stemmed from the bad practice of taking skin grafts from other people, which does not work even today. Short of being identical twins, only autografts work.

Then there’s the Italian Method. Tagliacozzi (who was pretty much the only practitioner of it, even in his own time) would do the same as the Indian method, except the skin flap was taken from the upper arm, which would then have to be belted to your face for the 14 day grafting period, at which point he would sever the graft from the arm and then keep you on bed rest for another 25 days to 5 months. This was understandably uncomfortable, and carried a high risk of permanent contractures in the affected arm – meaning it could be permanently locked in a bent shape, unable to extend or contract. This, understandably, sucked. Nonetheless, he boasted that his method made noses better than the originals (and had little to say about contractures), but few surgeons kept up his technique after his death. Yet his motto lives on in the hearts of plastic surgeon around the world:

“We restore, rebuild, and make whole those parts which nature hath given, but which fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.”

 

However, as wholesome as the mantra is, it was also not uncommon for persons of wealth to seek replacements of their nose not by grafts, but by prosthesis. Tycho Brahe, the boisterous astronomer of the 16th century, had a nose made of silver (though it may actually have been copper) after he lost his nose in a duel. Conveniently enough, both copper and silver not only look fly as heck, but they’re naturally antimicrobial – greatly reducing the likelihood of infection. The medievals may not have understood why exactly copper and silver were good for prosthetics and medical operations in general, but they knew that it worked and that was good enough.

 

Now. Applying this to other body parts:

The reason why these skin grafts kept the skin attached to the donor site until the graft healed was because they did not have the means to keep skin alive after it was separated from the body. Without at least some functional epithelial tissue to provide circulation, a graft would die before it could grow new granulation tissue to adhere to the new attachment site. Large burns across the body necessitating graft(s) might well be a death sentence regardless of the surgeon’s skill; there’s just not enough skin left. A crafty (read: desperate) surgeon might be able to literally stretch skin grafts to make them work, but there’s no guarantee that will work, and it may just destroy the graft; the equivalent modern technique is a heck of a lot more complicated.

One of the biggest related complications to burn injuries and skin grafts (and anything that requires bed rest) is pressure injuries; a patient who sits still without moving for more than a couple days is at a high risk of developing sores on bony prominences like the hip and sacrum (your tailbone) that squish your muscle / skin against whatever surface you’re laying on. If it goes on long enough, tissue will ulcerate, die, and rot away. This only gets worse with sacral injuries, as that is very close to your poopy hole – and bed rest also often means uncontrolled poo. Poo + open tissue = massive infection = death by poo. Poo itself can also rot away your skin – though not directly because of the poo, but just because moisture is a breeding ground for bacteria and fungus which then eat the skin, and the poo happens to provide lots of nutritious organic matter for micro-organisms to proliferate on.

Someone who has full body burns is going to have a rough time of lying still enough to heal and moving about enough to ward off pressure injuries. The standard medical prescription these days is to rotate the patient every 2 hours (whether we do it or the patient does, doesn’t matter). I am not sure if medieval medical literature recorded this practice, but the patient would have eventually gotten uncomfortable sitting in the same position for hours on end, while any sort of open wound would not have been sat upon – it’s common sense. It hurts a lot, why would you sit on it?

 

And yes, mandrake root was historically used as an anesthetic, and widely so. It doesn’t reduce pain, it just knocks you out. Or causes wild hallucinations. Or death. A note from the poison post above – a number of neurotoxic substances were also historically used as medicines, in addition to their more homicidal applications – to variable effect.

One of the unfair advantages of the East was their access to opium – from which we derive modern morphine (and also heroin, which is not as helpful). Although highly addictive, it is a powerful painkiller, and while very much still capable of killing you, significantly less likely to do so by accident.