The tissues composing the face are extremely vascular, hence hemorrhage is profuse and hemostasis should be exact. By virtue of this same rich blood supply the process of repair is prompt and satisfactory, if sources of infection be avoided. Patients here, more than anywhere else, desire a minimum of scar. Incisions, then, should be so planned as to permit the utilization of the natural folds or grooves of the face. They should also be so made as to avoid injury to main trunks of vessels and nerves, as well as to Stenson’s duet. Sharp knives and the least possible bruising of the tissues help to ensure the desired result. When possible a subcutaneous suture should be employed. When this is not sufficient fine needles and fine suture material should be used. A reasonably short, clean wound upon the face, especially in the neighborhood of the mouth, should be protected from the air until it is dry, using a dusting powder and then covering with collodion. In extensive operations provisional or permanent ligation of the carotid may be necessary; usually the external branch will suffice. In every instance plastic repair should be made, as it will always be required after the excision of growths involving the surface.
Space does not permit of detailed or specific directions for all possible methods of plastic repair of facial defects, but [Figs. 421] to [441] illustrate the principal methods which may be utilized in planning and sliding flaps which shall serve this purpose. These may be modified or combined to meet special indications.
Fig. 432
Fig. 433
Fig. 434
Fig. 435
Fig. 436
Fig. 437
