Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The patient, being now in readiness, the skin over the area is lifted or
pinched up with the fingers of the left hand of the operator as a guide
to its mobility and to steady the part.
The point of the needle is now forced through the skin and into the
subcutaneous tissue at a point along the periphery of the deformity and
pushed a little beyond the center of the cavity to be filled.
The elevation of the skin is in the meantime partly kept up with the
needle itself, while the syringe is grasped with the freed hand, the
thumb and forefinger of the right hand being placed upon the handle of
the screw or piston rod, which they must rotate to force the semisolid
mass from the instrument.
Before beginning the injection an assistant is instructed to press
with his fingers the tissue about the margin of the defect to prevent
the filling from becoming misplaced or being forced into undesirable
channels, especially if the skin over the defect is found to be thick and
inelastic.
The screw handle is now rotated evenly and slowly, discharging the mass
to be injected, which will soon be evidenced by the rise of the skin over
the depression to be corrected.
Only sufficient of the mass must be injected to fairly correct, never to
overcorrect, the defect.
Experience alone will assure the surgeon when this point has been
attained, since he cannot immediately judge the necessary amount
injected, as it will appear as a round or irregular lump under the skin,
until it has been molded or worked out into shape.
Owing to the pressure exerted upon the contents of the syringe, which
will continue to emerge from the needle for a time, the needle is left
in place for a few seconds before withdrawal, so that the needle canal
through the skin will not become filled with the semisolid mixture.
Such blocking up of the opening causes a cystic development or
enlargement about the opening in the skin by this backing up or
exuding, ofttimes crowding itself in between the layers of the skin and
necessitating later removal with the knife. If not this fault it tends to
keep the wound open unnecessarily after the operation, preventing healing
and permitting the escape of a certain amount of the injected mass, if a
mixture of low melting point has been utilized.
The needle, having been allowed to remain as advised, is now withdrawn.
The tip of one finger is placed over the opening in the skin and held
there gently, but firmly, while the mass is molded into the shape
required or desired with the fingers of the right hand.
If it now appears that the injection is insufficient the needle may again
be introduced through the same opening and more is injected, remembering,
however, that if the correction is quite normal no more should be added
for several days, or until the injected mass has become organized, which
should take place in about three weeks.
Public-domain text, read in full here on John Shaqi.
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