Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
If it is found that the skin over the defect is inflexible and bound
down, it will be found advisable to sever or dissect subcutaneously
the adhesions that bind it down with the use of a fine tenotome or a
spear-headed paracentesis knife.
This may be done two or three days before the parts are injected to
assure the surgeon of an absolute cleanliness of the wound.
Mayo advocates the injection of a saline solution into subcutaneous
wounds thus made as a guide to the extent of dissection and to further
loosen the tissues.
When the parts, thus loosened, show little tendency to bleed, the author
advocates immediate injection, as the waiting for several days permits
the throwing out of new connective-tissue cells that interfere to a
certain extent with the proper injection of the part.
It is with such wounds that secondary elimination is most likely to take
place, especially if “Hart paraffin” or paraffin of a high melting point
has been employed.
This is undoubtedly due to the healing down and contraction of the
margins of the wound, which seems to progress more and more, encroaching
eventually upon the hard mass and ending in inflammation of the overlying
skin and ultimate elimination. With injections of softer consistency
this is less frequent and, in fact, may be entirely overcome by limiting
the amount of the injection at the first sitting, relying upon a full
correction for later operations, when the periphery of the wound has
become more or less influenced by the presence of the neutral mass
between the wounded surfaces.
The subcutaneous dissection referred to must, of course, be done under
local anesthesia, preferably the Schleich mixture or a one-per-cent
solution of Eucain β.
The injection of the paraffin, or hydrocarbon mixture, in semisolid
form, having been made and properly molded into shape, is set or fixed
by spraying the part with ether or by the application of sterile ice
cloths. When liquid paraffin has been injected it will be noted that the
paraffin in setting contracts upon itself considerably, leaving less of a
correction than anticipated.
The needle opening in the skin is next washed off with a
twenty-five-per-cent solution of hydrogen peroxid and closed over with a
drop of collodion.
The patient may then be discharged for the time being, with the
instruction to apply ice cloths to the part for at least twelve hours to
reduce, as far as possible, the reactive resultant inflammation.
On the third day the collodion patch may be removed and replaced with
isinglass adhesive plaster applied with an antiseptic solution. The
latter is allowed to remain on the skin until it falls off.
SPECIFIC CLASSIFICATION FOR THE EMPLOYMENT AND INDICATION OF HYDROCARBON
PROTHESES ABOUT THE FACE
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