Plastic and cosmetic surgery

by Frederick Strange Kolle

This is best accomplished with a disk of aluminium, bent to conform to the shape of the part operated, lined with sterilized lint and fixed over the site by strips of Z. O. plaster.

While the hyperinjection of vaselin is not as objectionable as that of paraffin, because of the more ready accommodation and absorption of the mass, it nevertheless leads to diffusion of the material, owing to its softer consistency and consequent greater facility in seeking fine avenues of escape, paraffin having the advantage of cooling upon itself en masse, leaving little to escape into undesirable channels after it has once been molded and set.

Vasserman cites a case in which gangrene of the bridge of the nose resulted after an injection of 2.05 c.c. of vaselin.

However, when these faults occur they are errors of technique, and should be avoided, as has been mentioned heretofore.

The removal of such hyperinjected masses by the aid of paraffin solvents, such as benzine, ether, chloroform, or xycol, applied to the skin above the filling, has proved a failure, nor will heat used externally in the same manner remedy evil.

What is left to the operator is to open the skin and, with a small, sharp spoon curette, remove the mass early, before it has become organized, or to excise the new connective tissue and the broken-down filling, as mentioned.

When, however, the tumefaction resulting from such hyperinjection is not extensive, as is often found about the chin and at the root of the nose, the secondary deformity can be materially, if not entirely, remedied by electrolysis. A needle or brooch of certain hardness is to be employed, connected with the negative pole of a continuous current apparatus. From twelve to twenty milliampères are required. The process is similar to that used with the destruction of hair, nævi, or moles on the face. The needle should puncture the entire tumor or penetrate its maximum diameter and be charged with the current for two or three minutes. Several of such punctures should be made at each sitting, the latter being repeated as often as is deemed necessary by the operator. The reaction which follows this procedure is of little moment, and these sittings can be undertaken every three or four days.

While this method is liable to leave little punctuate scars at the sites where the needle is introduced, it is nevertheless more satisfactory than the linear scar made with the knife, to the use of which the patient may, on the other hand, object, not to speak of the difficulty and unsatisfactory results usually obtained therewith.

9. Air Embolism.—The fault of introducing air under the skin with the syringe at the time of injection can only be the result of flagrant negligence. Every physician should know enough to hold the syringe in an erect or vertical position, and to expel the air above the solution in his syringe, as is done with any hypodermic injection.

Air embolisms are also occasioned by a careless filling of the syringe with the hydrocarbon in a cold state, as the material is now generally used, and while the dangers of such emboli are very much exaggerated they should not be permitted, when by the pouring in of the liquefied material the syringe can be filled evenly.