IV. Implantation of pedunculated flaps by bridging.
V. Transplantation of nonpedunculated flaps or skin grafting.
This classification differs from that heretofore generally given in the meager literature on the subject, but the author believes his arrangement to be more scientifically exact as well as simpler for recording and history purposes.
I. Stretching Method
In the stretching method the defect is neatly excised, so as to freshen the margins to be brought together. It may be necessary, if the defect is too large for free apposition, to dissect the skin away from the underlying tissue to render it more movable and to overcome tension. The shape of the incision depends largely upon the nature of the defect and must be made with a view of leaving as little scar as possible. Where the defect is somewhat linear, or elongated, an elliptical incision (A) is made, as in [Fig. 44], and, if necessary because of too great tension, the skin is undermined sufficiently to allow the parts to come together; if this cannot be done readily, two semilunar incisions (b, b) must be added. This will allow of ready coaptation. The wound is then brought together with an interrupted suture, appearing as in [Fig. 44a], the semilunar spaces being allowed to heal by granulation.
Fig. 44.
Celsus Incisions.
Fig. 44a.