Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
Especially have cases in which the injections of paraffin were made
submucously for the correction of atrophic coryza shown embolic
tendencies. This is especially true when paraffins of high melting points
have been employed, as in the case of Pfannenstiel, in which instance
the condition of the mass permitted of freer absorption or the high
temperature caused a coagulation of the blood in the veins, leading to
thrombosis and embolism, and when the amount of such an injection is so
large as to prevent cooling and hardening in the normal space of time
added to the quantity and associated at the same time with consequent
pressure, predisposing to absorption or dissemination, especially if the
injection be made into the parenchymatous instead of the subcutaneous
tissue.
Comstock, in his experience on animals, states that “in all cases in
which paraffin was used at 102° F. the animals died within two weeks’
time, hence the specimens at that temperature are limited (death being by
thrombosis). In all other cases with the higher melting point, 110° F.,
no unpleasant results were experienced.”
Hurd and Holden have observed a patient who had previously undergone two
injections of paraffin for the correction of a depression in the upper
part of the nose. A third injection was advised and made under the same
conditions as the first, except that no cocain anesthesia was employed,
the paraffin being at same temperature as before.
The moment the injection was made complete blindness in the right eye
resulted, while a small ecchymotic spot appeared at the site of the
needle insertion in the skin. Half an hour later an examination of
the eye showed the right pupil dilated and inactive light stimulus,
the patient being unable to distinguish light from darkness.
Ophthalmoscopically the lower branch of the central retinal artery and
its subdivisions were found to be empty and in a state of collapse,
evidenced by their pale appearance. The upper branch of the same vessel
was found to be poorly filled.
The authors endeavored to remove the embolism to a collateral branch of
the artery by the use of amyl nitrate, digitalis, and pressure on the
globe of the eye, with no effect. Some hours later edema of the retina
appeared, followed by permanent loss of sight. The same authors have
observed several cases of pulmonary embolism result from the injection of
paraffin.
It is also a fact that injections of the nature being considered, while
not causing immediate embolism, may do so as a result of phlebitis,
caused by a direct injection into the vein or over or upon it in such a
way as to cause irritation.
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