Plastic and cosmetic surgery

by Frederick Strange Kolle

It is rather infrequent to use permanent dressings in plastic surgery, but where the wound appears aseptic, with a dry serous crust over the line of healing, it should not be disturbed except for mechanical reasons. The latter are caused by the coagulated mixture of the wound secretion and the antiseptic powder used, often aggravated by the median knotting of sutures or the careless disposition of the loose suture ends. Not too much can be said of carefully folding the free silk suture ends at right angles to the incisions. The ends, moistened subcutaneously, are very liable to take on septic infection and communicate it to the wound—crowded into the very wound. When becoming embodied in the coagula of serum and antiseptic powder it prevents, by pressure, perfect union, causing a wider scar at such point, as well as endangering the asepsis of the wound by being pulled off accidentally, thus tearing it open and bringing on hemorrhage.

The appearance of the resulting scar in facial surgery is often of as much importance to the patient as the operation itself, therefore, all care should be exercised in bringing about the very best result.

For this reason, a patient in poor health should not be operated upon, and any erosion of the skin about the seat of operation should be thoroughly healed before attempting plastic work. Aristol dusted on an abrasion will heal it quickly.

If hemorrhage follows the dressings of a wound, the dressing should be removed and the hemorrhage controlled by pressure, unless severe, and be redressed. Moist blood decomposes readily and is a source of early infection, unless careful drainage under antisepsis is established. At no time should any part of the wound be unnecessarily exposed directly to the air. For small wounds, silk protective plaster may be used to cover the gauze dressing, while sterile gauze bandages should keep dressings of large area in place.

Bandages, when changed, should be cut away with the aid of the Lazarewitch angular bandage scissors and not be unwound. It is quicker and the undue pulling of such, when glued by secretions, is liable to disturb the healing of wounds and even result in the tearing out of sutures.

The patient should never be intrusted to dress wounds himself. In cases where the dressings cannot be changed frequently proper precautions for drainage and comfort must be observed. The temperature of the patient should be taken twice daily; any elevation thereof may indicate septic infection and demand immediate attention.

When a portion of the ear, nose, or lip has been severed by injury, the part may be put back into place and held by sutures and aseptic Z. O. strips, powdered with aristol and properly dressed. Union usually takes place, even in the most unexpected cases. None but incised wounds of such nature should be covered hermetically with collodium or plaster, as bruised surfaces so often in this kind of injury require perfect drainage. The retention of secretions produces infection, generally resulting in the entire loss of the part.

Wounds of the Mucous Membrane.—Wounds of the mucous membrane should be carefully drained and cleansed freely at frequent intervals, especially those about the mouth. Wounds of the cheek, if including the mucous membrane, should be especially cared for, as there is here the increased danger of infections from the secretions of the mouth.