Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
This, in the opinion of the author, is due to the binding down of the
marginal borders, which, in the event of partial extirpation, are not
injured sufficiently to displace them and that they unite again in their
former position. To overcome this it is found best to excise the entire
filling much beyond the margins and to apply pressure over the area until
perfect union has taken place.
This is best accomplished with a disk of aluminium, bent to conform to
the shape of the part operated, lined with sterilized lint and fixed over
the site by strips of Z. O. plaster.
While the hyperinjection of vaselin is not as objectionable as that of
paraffin, because of the more ready accommodation and absorption of
the mass, it nevertheless leads to diffusion of the material, owing to
its softer consistency and consequent greater facility in seeking fine
avenues of escape, paraffin having the advantage of cooling upon itself
_en masse_, leaving little to escape into undesirable channels after it
has once been molded and set.
Vasserman cites a case in which gangrene of the bridge of the nose
resulted after an injection of 2.05 c.c. of vaselin.
However, when these faults occur they are errors of technique, and should
be avoided, as has been mentioned heretofore.
The removal of such hyperinjected masses by the aid of paraffin solvents,
such as benzine, ether, chloroform, or xycol, applied to the skin above
the filling, has proved a failure, nor will heat used externally in the
same manner remedy evil.
What is left to the operator is to open the skin and, with a small, sharp
spoon curette, remove the mass early, before it has become organized,
or to excise the new connective tissue and the broken-down filling, as
mentioned.
When, however, the tumefaction resulting from such hyperinjection is not
extensive, as is often found about the chin and at the root of the nose,
the secondary deformity can be materially, if not entirely, remedied by
electrolysis. A needle or brooch of certain hardness is to be employed,
connected with the negative pole of a continuous current apparatus. From
twelve to twenty milliampères are required. The process is similar to
that used with the destruction of hair, nævi, or moles on the face. The
needle should puncture the entire tumor or penetrate its maximum diameter
and be charged with the current for two or three minutes. Several of such
punctures should be made at each sitting, the latter being repeated as
often as is deemed necessary by the operator. The reaction which follows
this procedure is of little moment, and these sittings can be undertaken
every three or four days.
While this method is liable to leave little punctuate scars at the sites
where the needle is introduced, it is nevertheless more satisfactory than
the linear scar made with the knife, to the use of which the patient
may, on the other hand, object, not to speak of the difficulty and
unsatisfactory results usually obtained therewith.
Public-domain text, read in full here on John Shaqi.
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