Fig. 197.—Hainsley Cheek Compressor.
The sutures may be removed as early as the sixth day, but it is best to release the wound sutures about this time, and leave the tension sutures for two or three days later.
It often happens that the entire wound has not healed by primary union, if this occurs and sufficient union has taken place in part of the lip, the wound should be allowed to heal by granulation.
Should the entire wound separate on the removal of the sutures, the operator may attempt to secure healing of the wound by applying a secondary suture to bring the granulating surfaces together, although little is gained by this procedure as a rule.
If reoperation becomes necessary, it should not be undertaken before six weeks or more have elapsed. At any rate not before the lip tissues have returned to their normal state. Inflamed tissues do not retain sutures well.
It usually becomes necessary to perform small cosmetic operations after the healing of harelip wounds. Those should not be undertaken until the child is of such age as to insure a perfect result.
SUPERIOR CHEILOPLASTY
Plastic operations for the reconstruction of the upper lip are not met with often in surgery, except in connection with the various forms of harelip. When the latter is not the cause, deficiencies of the upper lip are due to the ulcerative forms of syphilis, and are occasioned by the ablation of epithelioma and carcinoma or the result of burns or lupus. Rarely the surgeon will meet with such a defect caused by dog bite or other traumatisms due to direct violence, as in railroad or automobile accidents.
Classification of Deformities of Upper Lip
Berger has classified three degrees of this deformity, according to its severity, to wit: