Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
These pieces are placed upon the granulating surface and firmly pressed
into place, so that they are in close contact throughout their area.
Other pieces are placed quite near or even in contact with the edge of
the first, and so on, until the space is entirely covered. Boric-acid
dressing of any desired form is placed over them and superimposed by
loose gauze and bandage.
The dressing should be left undisturbed for at least forty-eight
hours, and then be gently removed and renewed. The utmost care should
be exercised with the dressings, since here lies the success of the
whole result. The blood dressings have given excellent results in cases
undertaken by the author, and should be resorted to whenever practicable.
The method has already been fully described, and does not differ in the
event of employing zoödermic grafts.
When boric-acid dressings are used, they should be changed every day
after the first dressing has been removed, so that the behavior of the
grafts can be closely watched.
Lazy grafts and those showing signs of sloughing should be removed at
once, and granulations crowding through the grafts should be snipped off
with a fine scissors, as they are liable to destroy the life of a graft
by pressure or by crowding it away from its bed of nourishment.
As in dermic grafts, the upper layers of these plaques will be thrown
off, giving at times the appearance of total sloughing, yet on
interference the deeper layers will be found to be intact and healthy.
The dressings should be continued until the grafts have not only
established their circulation, but until their edges have firmly united
and the surface has taken on a dull reddish color, which eventually fades
to a shade somewhat paler than the normal skin. The hairs that have been
carried over with the grafts at first seem to thrive, but eventually drop
out, leaving the surface bare. Spots of color so often observed in the
skin of the bellies of dogs also disappear from the grafts, leaving their
color uniform.
Amat, in 1895, claims that good results in skin-grafting are obtained by
substituting the epidermal pin grafts with the film or inner-shell lining
membrane of the fresh hen’s egg. For this purpose as fresh an egg as can
be obtained is used. It is broken along the horizontal axis. A delicate
forceps is now made to grasp the free membrane found at the air chamber
of the enlarged end of the egg. The inner lining is drawn away from the
shell in pieces four or five millimeters long; these pieces are cut with
a fine scissors into equal lengths and placed with the point of the
scissors to the granulating surface to be covered, in the same way as the
Reverdin grafts. Amat covered the grafts with tinfoil, over which were
placed several lays of carbolized gauze. The dressings were changed every
three or four days.
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