Volume 1

Operative surgery / by Joseph D. Bryant.

  • Joseph D. Bryant
Date:
1900-1901
Catalogue details

Licence: In copyright

Credit: Operative surgery / by Joseph D. Bryant. Source: Wellcome Collection.

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    the same line, but not so far outward. The angles at the outer ends of these two latter incisions are accurately united by a single-thread or fine silk- worm-gut suture. The freshly cut edges of skin and mucous membrane, above and below, that are to form the new lip borders, are to be shaped by paring first the skin and then the mucous membrane in such a manner that the latter shall overlap the former after they have been secured together bv fine sutures at short intervals. Serve’s Method.—Serre’s method is practiced for the restoration of the angle of the mouth (Fig. 710). Three incisions are made, a superior, external, and inferior. The first is placed horizontally in a line with the upper border of the mouth ; the second, beginning at the outer extremity Fig. 710.—Serre’s method. of the first, passes downward and inward near to the angle of the de- formity, and then directly downward for a short distance ; the third passes from the border of the lower lip just within the deformity, down- ward and outward to join the lower end of the second, thus forming a smaller triangle below with its base opposed to that of a larger one above. The circumscribed tissues are removed, the bases of the triangles caused to meet at the angle of the mouth, and the borders are joined with sutures. Meloplasty.—Meloplasty relates to the restoration of defects of the cheek dependent on cicatricial changes caused by noma, etc. The rules of action in this operation are substantially similar to those employed in plastic repairs of other parts. The utilization of skin from the neck and of that ad- jacent to the eyelids and the lips for flaps is objectionable, because of the disfigurement incident to con- traction, and when thus employed the probable need of a supplement- ary procedure should be well under- stood. In the instance of locked jaw from cicatricial tissue, the tis- sue must be dissected away freely and sound structures alone em- ployed in repair. Two flaps, the upper taken from the cheek and the lower from the cheek, neck, and chin, are employed sometimes to cure a crippling defect (Fig. 711). Fig. 711.—a. Meloplasty by the use of two pedunculated flaps from the cheek and chin. h. Condition after suture.