Plastic and Cosmetic Surgery

CHAPTER XIV. Subcutaneous Hydrocarbon Protheses

SUBCUTANEOUS HYDROCARBON PROTHESES

Indications—Precautions—The advantage of the method—Untoward results: Intoxication; Reaction; Infection; Necrosis; Sloughing; Sloughing due to pressure; Subinjection; Hyperinjection; Air embolism; Paraffin embolism; Primary diffusion or extension of paraffin; Interference with muscular action of the wings of the nose; Escape of paraffin after withdrawal of needle; Solidification of paraffin in needle; Absorption or disintegration of the paraffin; The difficulty of procuring paraffin with proper melting point; Hypersensitiveness of skin; Redness of the skin; Secondary diffusion of the injected mass; Hyperplasia of the connective tissue following the organization of injected matter; Yellow appearance and thickening of the skin after organization of the injected mass has taken place; The breaking down of tissue and resultant abscess due to the pressure of the injected mass upon the adjacent tissue after the injection has become organized—The proper instruments for the subcutaneous injection of hydrocarbon protheses—Preparation of the site of operation—Preparation of the instruments for operation—The practical technique—Specific classification for the employment and indication of hydrocarbon protheses about the face—Specific classification for the employment and indication of hydrocarbon protheses about the shoulders, etc.—Specific technique for the correction of regional deformities about the face: Transverse depressions; Deficient or receding forehead; Unilateral deficiency; Interciliary furrow; Temporal muscular deficiency; Deformities of the nose; Deformities about the mouth; Deformities about the cheeks; Deformities about the orbit; Deformities about the chin; Deformities about the ear—Specific technique for the correction of deformities about the shoulders 209

CHAPTER XV. Rhinoplasty

RHINOPLASTY

The causes of nasal destruction—Classification of deformities—Surgical technique—Protheses—Nasal replanting—Nasal transplanting—Total rhinoplasty: Pedunculated flap method; The Indian or Hindu method; The French method; The Italian method; The combined flap method; Organic support of nasal flaps; Periostitic supports; Osteoperiostitic supports; Cartilaginous support of flap—Partial rhinoplasty; Restoration of base of nose; Restoration of lobule and alæ; Restoration of the alæ; Restoration of nasal lobule; Restoration of subseptum 339

CHAPTER XVI. Cosmetic Rhinoplasty

COSMETIC RHINOPLASTY

Angular nasal deformity—Correction of elevated lobule—Correction of bulbous lobule—Angular excision to correct lobule—Correction of malformations about nasal lobule—Deficiency of nasal lobule—Correction of widened base of nose—Reduction of thickness of alæ—Correction of nasal deviation—Undue prominence of nasal process of the superior maxillary 448

CHAPTER XVII. Electrolysis in Dermatology

ELECTROLYSIS IN DERMATOLOGY

The electric battery—The voltage or electromotive force—Cell selector—Milliampèremeter—The electric current—Portable batteries—Electrodes—Removal of superfluous hair—Removal of moles or other facial growths—Telangiectasis—Removal of nævi—Removal of tattoo marks—The treatment of scars 470

CHAPTER XVIII. Case Recording Methods

CASE RECORDING METHODS

Photographs—Stencil record—The rubber stamp—The plaster cast—Preparation of photographs 491

LIST OF ILLUSTRATIONS

=Transcriber’s Note:= Some illustrations have been moved to where they fit best with the surrounding text.

FIG. PAGE

A. Cornelius Celsus (“Father of Plastic Surgery”). Frontispiece

HISTORICAL

1.—Celsus incision for restoration of defect 2

2.—Celsus incision to relieve tension 2

REQUIREMENTS FOR OPERATING

3.—Formaldehyd disinfecting apparatus 11

4.—Instrument cabinet 12

5.—Operating table 13

6.—Instrument table 14

7.—Irrigator 15

8.—Instrument sterilizer 16

9.—Aseptic washstand 17

10.—Von Bergman operating gown 19

11.—Triffe rubber apron 19

REQUIREMENTS DURING OPERATION

12.—Basins and rack 23

13.—Willy Meyer sterilizer 25

14.—Wallace sterilizer 25

15.—Sprague type of sterilizer 26

16.—Sterilizing plant 28

17.—Dressing case 29

18.—Combination dressing case and table 29

19.—Waste pail 30

20.—Clark Kumol apparatus 32

WOUND DRESSING

21, 22.—Plaster sutures 46

23, 24.—Angular plaster sutures 46

SECONDARY ANTISEPSIS

25.—Walcher dressing forceps 55

26.—Toothed seizing forceps 55

ANESTHETICS

27.—Schimmelbusch dropping bottle 60

28.—Esmarch dropping bottle 60

29.—Schimmelbusch folding mask 61

30.—Esmarch inhaler 61

31.—Allis inhaler 65

32.—Fowler inhaler 65

33.—Juillard mask 66

34.—Simplex syringe 72

35.—Kolle improved Pravaz syringe 72

36.—“Sub-Q” syringe 72

PRINCIPLES OF PLASTIC SURGERY

37.—⅝ circle Haagedorn needles 77

38.—Crescent curve Haagedorn needles 77

39.—Kersten-Mathieu needle holder 78

40.—Haagedorn needle holder 78

41.—Pozzi-Haagedorn needle holder 78

42.—Weber-Haagedorn needle holder 78

43.—Needleholder with suture carrier 78

44.—Celsus skin incisions 80

44 a.—Celsus relieving incisions 80

45.—Rhomboid excision 80

46.—Union of rhomboid excision 80

47.—Oblong excision 81

48.—Coaptation of wound 81

49.—Bitriangular excision 81

50.—Linear coaptation 81

51.—Triangular excision 81

52.—Coaptation of wound 81

53.—Triangular excision with relieving incisions 82

54.—Coaptation of wound 82

55.—Square excision 82

56.—Coaptation of wound 82

57.—Square excision 82

58.—Coaptation of flaps 82

59.—Triangular excision 83

60.—Coaptation of flap 83

61.—Triangular excision 83

62.—Coaptation of flaps 83

63.—Triangular excision 83

64.—Arrangement of flaps 83

65.—Double triangular excision 84

66.—Coaptation of wound 84

67.—Tri-triangular excision 84

68.—Coaptation of wound 84

69.—Rectangular-bitriangular excision 84

70.—Coaptation of wound 84

71.—Weber excision method 85

72.—Coaptation of flaps 85

73.—Elliptical excision 85

74.—Coaptation of flaps 85

75.—Triangular excision 86

76.—Coaptation of flaps 86

77.—Triangular excision 86

78.—Coaptation of flaps 86

79.—Lentenner method of excision 86

80.—Coaptation of flap 86

81.—Burns method of excision 87

82.—Coaptation of flaps 87

83.—Tagliacozza harness 87

84.—Smith skin-grafting scissors 89

85.—Thiersch skin-grafting razor 93

86.—Thiersch folding razor 93

87.—Method of cutting Thiersch graft 94

88.—Method of placing Thiersch graft 95

BLEPHAROPLASTY

89.—Correction of ectropion, Dieffenbach method 104

90 a and b.—Correction of partial ectropion (author’s case) 104

91, 92.—Complete ectropion, Dieffenbach method 106

93, 94.—Complete ectropion, Wolfe method 107

95, 96.—Complete ectropion, Fricke method 108

97, 98.—Complete ectropion, Ammon-Von Langenbeck method 109

99, 100.—Complete ectropion, Dieffenbach-Serre method 110

101, 102, 103.—Complete ectropion, Tripier method 111

104, 105.—Complete ectropion, Von Artha method 112

106, 107.—Epicanthus, Bull method 113

108.—Probe-pointer angular scissors 114

109, 110, 111.—External canthoplasty 115

112, 113.—Blepharoplastics, author’s method 116

114.—Curved eye scissors 117

OTOPLASTY

115.—Partial restoration of the auricle 124

116.—Correction of lobular defect 126

117.—Coaptation of wound 126

118, 119.—Greene method correcting coloboma 126

120.—Noyes’s clamp 127

121, 122.—Correction of attached lobe 128

123.—Restoration of auricle, Szymanowski method 129

124.—Auricular stump for attachment of artificial ear 130

125.—Auricular prothesis 130

126.—Auricular prothesis applied to stump 131

127.—Anterior view of auricular prothesis 131

128.—Posterior view of auricular prothesis 131

129, 130, 131.—Schwartze method of correction of macrotia 134

132, 133.—Parkhill method of correction of macrotia 135

134, 135.—Author’s method of correction of macrotia 137

136, 137.—Author’s method of correction of macrotia 137

138.—Monks’ method of correction of malposed ear 139

139, 140.—Author’s method of correction of malposed ear 140

141, 142.—Correction of malposed auricles, author’s case (anterior view) 142

143, 144.—Posterior view of replaced auricles 143

CHEILOPLASTY

145.—Burchardt compression forceps 145

146.—Beinl harelip clamp 145

147.—Median cleft, Siegel’s case 147

148.—Median cleft with rhinophyma, Trendelenburg’s case 147

149, 150, 151.—Types of unilateral labial cleft 148

152.—Unilateral facial cleft, Hasselmann 149

153.—Bilateral facial cleft, Guersant 149

154.—Buccal fissure with macrostoma 150

155, 156, 157.—Harelip correction, Nélaton method 152

158, 159.—Harelip correction, Fillebrown method 153

160, 161, 162.—Harelip correction, Von Langenbeck-Wolff-Sedillot method 153

163, 164, 165.—Harelip correction, Malgaigne method 154

166, 167.—Harelip correction, Gräfe method 154

168, 169, 170.—Harelip correction, Mirault method 155

171, 172, 173.—Harelip correction, Giralde method 155

174, 175, 176.—Harelip correction, König method 156

177, 178, 179.—Harelip correction, Maas method 156

180, 181, 182.—Harelip correction, Haagedorn method 157

183, 184, 185.—Harelip correction, Dieffenbach method 157

186, 187.—Correction bilateral cleft, Von Esmarch method 159

188, 189, 190.—Correction bilateral cleft, Maas method 159

191, 192, 193.—Correction bilateral cleft, Haagedorn method 160

194, 195, 196.—Correction bilateral cleft, Simon method 160

197.—Hainsley cheek compressor 161

198, 199.—Superior cheiloplasty, Bruns method 164

200, 201.—Superior cheiloplasty, Sedillot method 165

202.—Superior cheiloplasty, Buck method 165

203, 204, 205.—Superior cheiloplasty, Estlander method 166

206, 207.—Inferior cheiloplasty, Richerand method 169

208, 209.—Extirpation of vermilion border 169

210, 211.—Inferior cheiloplasty, Celsus method with additional incisions 170

212, 213.—Inferior cheiloplasty, Estlander method 171

214, 215.—Inferior cheiloplasty, Bruns method 172

216, 217.—Inferior cheiloplasty, Buck method 172

218, 219.—Inferior cheiloplasty, Dieffenbach method 173

220, 221.—Inferior cheiloplasty, Jäsche method 174

222, 223.—Inferior cheiloplasty, Trendelenburg method 174

224, 225.—Inferior cheiloplasty, Bruns method 175

226, 227.—Inferior cheiloplasty, Bruns bilateral method 175

228, 229, 230.—Inferior cheiloplasty, Buchanan method 176

231, 232.—Inferior cheiloplasty, Syme method 177

233, 234.—Inferior cheiloplasty, Blasius method 178

235, 236.—Inferior cheiloplasty, Bürow method 178

237, 238.—Inferior cheiloplasty, von Langenbeck 179

239, 240.—Inferior cheiloplasty, Morgan method 180

241, 242.—Inferior cheiloplasty, Zeis method 181

243, 244.—Inferior cheiloplasty, Delpech method 182

245, 246.—Inferior cheiloplasty, Teale method 185

247, 248.—Labial ectropion, author’s method 187

249, 250.—Labial ectropion, author’s method 188

STOMATOPLASTY

251, 252.—Correction of Macrostoma, Dieffenbach-Von Langenbeck method 193

253, 254.—Correction of Macrostoma, author’s method 195

255, 256.—Correction of Microstoma, Dieffenbach method 196

257.—Artificial mouth, Heuter 196

MELOPLASTY

258, 259.—Meloplasty, Serre method 199

260, 261.—Correction of angle of mouth 200

262, 263.—Correction of extensive angle of mouth 200

264, 265.—Meloplasty, Kraske method 201

266, 267, 268.—Meloplasty, Israel method 202

269, 270.—Meloplasty, Bardenheuer 202

271, 272, 273, 274.—Meloplasty, Bardenheuer 203

275, 276, 277, 278.—Meloplasty, Bardenheuer 204

279, 280.—Meloplasty, Staffel 205

281.—Cheek prothesis after removal of sarcoma, Martin 206

282.—Prothesis applied to face 207

SUBCUTANEOUS HYDROCARBON PROTHESES

283.—Circulation of the head (author) Facing 210

284.—Eckstein insulated syringe 232

285.—Quinlan paraffin heater 232

286.—Author’s electrothermic paraffin heater 244

287.—Smith paraffin heater 246

288 a, 288 b.—Microphotograph, showing fibromatosis Facing 258

289.—Author’s drop syringe 265

290.—Author’s all-metal syringe 266

291.—Smith’s all-metal syringe 267

292, 293.—Anterior superior third nasal deficiency and correction thereof 289

294, 295.—Anterior median third nasal deficiency and correction thereof 292

296, 297.—Anterior inferior third nasal deficiency and correction thereof 294

298 a, 298 b.—Anterior superior and inferior third nasal deficiency and correction thereof 301

299, 300.—Anterior total nasal deficiency and corrections thereof 303

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