File:The principles and practice of surgery (1872) (14784782252).jpg

English: Fig. A. Incisions for closure of chasm by reversal of the integuments; from an operation by the Author. Fig. B. Same after closure and cicatrization [healing].

Identifier: principlespracti1872hami (find matches)
Title: The principles and practice of surgery
Year: 1872 (1870s)
Authors: Hamilton, Frank Hastings, 1813-1886
Subjects: Surgery General Surgery
Publisher: New York : W. Wood & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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Text Appearing Before Image:
-ing rules and methods of practice are recommended. First operation; for the closure of the nasal chasm.—Hitherto thisoperation—which I regard as preliminary and as essential to success inthe class of cases now under consideration—has not been thought neces-sary, but the transplanted integument designed to form the new nosehas been laid over the chasm, and attached only to its margins, or to theintegument but little removed from the margins, consequently the cen-tre of the flap has had no support, and was liable to fall through whenthe opening was very large, or at least to become very much flattened. The opening, if small, may be closed by freshening the margins, and,after lifting the adjacent integument by subcutaneous dissection,, slid- 608 SUEGEEY OF THE NOSE. ing the flaps thus constructed to the median line and uniting them bysutures; or, in case the chasm is very large, the integument may bedissected from the cheeks on either side, lifted and reversed. By this Fig. 523 B.
Text Appearing After Image:
Pig. A. Incisions for closure of chasm by reversal of the integuments ; from an operation by the Author.Pig. B. Same after closure and cicatrization. plan the raw surfaces of the flaps are left exposed, and the tegumentarysurface forms the lining of the roof of the nose, the free margins of theflaps being united in the median line by sutures. The union will occurall the more readily because the flaps are separated from the integu-ment of the face, and are subjected to no strain. In a few weeks theentire surface will cicatrize, and the first step of the operation will be com-pleted. Between this operation and the next following, an interval ofat least eight weeks should intervene. Second Operation.—1. A piece of leather or of pasteboard, previous-ly moistened, is cut of the size and shape of the proposed tegumentaryflap, and laid upon the centre of the forehead in a position the reverseof that which the flap is to occupy upon the vestige of nose. 2. Witha camels-hair pencil, moistene

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