Ununited fracture successfully treated : with remarks on the operation / By Henry J. Bigelow ... With abstracts from Dr. Bigelow's clinical lectures on the subject, and cases. (Reported by Richard H. Derby.).

  • Bigelow, Henry Jacob, 1818-1890.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: Ununited fracture successfully treated : with remarks on the operation / By Henry J. Bigelow ... With abstracts from Dr. Bigelow's clinical lectures on the subject, and cases. (Reported by Richard H. Derby.). Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    margin of the aim remains half an inch wide and retracted into the cavity of the nose, especially upon the right side. 15th.— Operation by Dr. Bigelow. The aim were dissected from their adhesions within the nasal cavity, and being cut square, left a margin a quarter of an inch in width. A flap was taken from the fore- head, in the usual way, and brought into place so as to form a nose and unite at its lower margin, with that of the aim and septum. In dissecting up the flap, the periosteum to which it was attached was carefully removed from the skull, in the hope that it would form a new bridge. 16th.—Wound looking well. 19th.—Every other suture removed. 20th.—Remaining sutures removed. 25th.-—It is now evident that the exposed bone is‘becoming necrosed. March 2d, 1867.—The margins of the wound upon the forehead have shown little tendency to approximate over the exposed surface of bone, the whole of which is dead, and is becoming gradually elas- tic and detached from the subjacent tissue. To-day (eleven weeks after the operation), forceps were introduced at the edge of the wound and the entire bony surface lifted off in two fragments, being itself a scale of almost papery thinness, covering a healthy granule ting surface. •jlst. Patient was etherized, the pedicle divided, and the eyebrow transplanted to its normal position. April 80th.—Wound of the forehead completely healed. May 15th.—No bone can be detected in the new nose. Remarks.—Having, in four previous instances, had occasion to make an entire new nose from the forehead, and having been on the whole dissatisfied, owing to the tendency of the new nose to flatten, with the want of resemblance in the result of my own efforts to the classical nose usually portrayed in standard works on surgery as the result of the rhinoplastic operation, I determined in this instance to invoke the aid of the periosteum in the formation of a new bridge. This had already been done abroadj with what result, I have not learned. I had, however, been previously deterred from the experi- ment, in apprehension of the injury to the bone, which has been men- tioned as having occurred in the present case. The necrosis of the whole surface of the exposed, bone, in connection with the entire ab- sence of osseous formation in the new nose five months after the operation, is not favorable, so far as the evidence of a single case may be relied on, to a repetition of this experiment. It may be added that the cicatrix of the forehead is more than usually pro- nounced. J 1 4