Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
For very small scars, as those occasioned by blepharoplastic operation,
the author employs the twenty-per-cent thiosinamin plaster mull made
by Unna. These are to be applied every day or night, according to the
convenience of the patient, and allowed to remain on for several hours
each day.
At first these plaster mulls are inclined to cause erythema and
exfoliation of the epithelium, therefore they might be used on alternate
days to keep the parts more sightly.
For scars of large extent the above method will answer best. If there is
considerable contraction, the parts should be massaged daily to soften
and stretch them. Eventually the depression of contour may be corrected
by hydrocarbon protheses introduced subcutaneously following subcutaneous
dissection, if deemed necessary.
Small pits, where discrete, are best removed with a fine knife and
brought together by a fine suture which is to be removed on the fifth day.
Confluent pittings, as after variola, must be removed by decortication or
peeling methods.
The pits, if spread about the face promiscuously, may be treated
separately by the peeling method, but when they lie less than one inch
apart, it is best to treat the skin of the whole face.
This is done by applying pure liquid carbolic acid to the skin with a
cotton swab. The skin at once assumes a white color. If the pittings are
not very deep, one application of the acid is sufficient. If deep, one or
two more applications are made as the preceding one dries. In very deep
pits, the surgeon should apply the acid to the pit proper several times,
blending off the application at the periphery.
When the surface thus treated has become dry, adhesive plaster, cut in
half-inch strips of desirable length, are put on the face, one above the
other, slightly overlapping, until the whole treated surface is well
covered, mask-like.
The author uses Unna’s zinc oxide plaster mull for this purpose, as it is
backed with gutta-percha, which readily adapts itself to the curvatures
of contour.
The adhesive plaster mask is not removed until about the fourth or
fifth day, when it will be practically forced away from the skin by the
excretions thrown out from the derma. In some cases there is considerable
pus.
After removal of the mask the skin, now very red and tender, is cleansed
with a solution of bichloride, 1 in 10,000.
After the cleansing a mild soothing ointment, such as zinc oxide in
vaselin, is used for several days until the skin takes on its normal
epitheliar layer and appears normal in color.
No water or soaps are to be allowed during the latter period. In the
later days of the treatment the skin may be cleansed with a little
borated vaselin or even olive oil used with absorbent cotton.
If there is a pigmentation of the new skin this should cause no alarm, as
it will fade out in from six to eight weeks.
Tincture of iodine has been used for the same purpose, as well as its
mixture with carbolic acid.
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