Plastic and cosmetic surgery

by Frederick Strange Kolle

Having determined upon the method to be followed in securing the flap, the surgeon is advised to consider such apparatus as he may be able to procure to retain the parts, or to use his own ingenuity to construct one of plaster-of-Paris bandages to meet the requirements of the case at not only less expense, but with greater comfort to the patient. At best, any apparatus employed will do little to overcome the agony of the retained member, which must be held in position.

Various operators give this period between six and twenty days. The apparatus should be so constructed that dressings can be easily made without discomfort to the patient, and without doing damage to the parts, and also to expose the face of the patient as much as possible. The various operations employed to perform total rhinoplasty by the Italian method may now be considered.

Tagliacozzi Method.—This surgeon resorted to four steps to accomplish his operations, which were:

I. Massage of or stretching the skin of the part from which the flap is to be made.

II. Cutting the flap, and allowing the same to cicatrize.

III. Freshening the flap and suturing in place, and use of apparatus.

IV. Cutting the pedicle and making the subseptum.

The various details of these steps should be considered here, since the methods are practically the same for all other operations of this kind, except in certain particulars as to time and mode of procedure.

I. Massaging the tissue of the arm to render it supple. This is of some consequence, in some cases, where the skin is tense, but requires no especial description.

II. He then compressed a fold of the skin with a large forceps at the lower half of the biceps. Upon opening these forceps he forced a bistoury under the skin fold and cut down toward the elbow-joint a distance sufficient to form a flap. This gave him a piece of raised skin, attached at either end, double the size of that required to make the nose. Under this he introduced linen mesh dressings in the form of a seton, with the object of irritating the skin to encourage the circulation, and render it thicker by consequent suppurations and granulations. This was continued for fifteen days, when the skin was detached at its upper end, leaving it attached by the lower or wider pedicle intended for the base of the nose. The flap was now turned down and both flap and wound were allowed to cicatrize.