On some important advantages to be secured by oblique section of the skin in surgical operations / by John H. Packard.

  • Packard, John H. (John Hooker), 1832-1907.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On some important advantages to be secured by oblique section of the skin in surgical operations / by John H. Packard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Unless exception is taken to the correctness of these premises, an apology will hardly be needed for the suggestions to which your attention is now asked. About six years ago, I was accidentally led to notice the fact that after oblique division of the skin, healing took place readily, and the resulting scar was small as compared with that usually left by vertical section. I was summoned to a woman who, while carrying a glass dish, had fallen and sustained a very severe wound of the hand from a sharp fragment of the glass. This wound was on the back of the hand, and extended from the wrist to the knuckle of the ring-finger. By the peculiar position « of the edge of the fragment, the skin had been cleanly divided in an extremely oblique direction. Healing took place promptly, and to my surprise and the patient’s gratification, the cicatrix was very much smaller than might have been expected after an injury so formidable in appearance as this had been. It occurred to me to imitate this accident in surgical procedures, with the view simply of lessening the ensuing disfigurement; nor was I disappointed. On one occasion, having removed an old bursal tumor from over the patella, I was unable to find the line of junction between the edges of the section of the skin. Now the mere lessening of scars has more than a cosmetic value. Every one knows how apt they are to be for a long time the seat of tenderness, sometimes exquisite, and how sensitive they often are to cold, as well as to barometric changes. By reducing the exposed portion of cicatrix, we do much to obviate these incon- veniences, which are especially annoying to the working classes, among whom the accidents requiring operation are by far the most frequently met with. Another danger to which scars are very liable is that of the development of keloid tumors; and the closer the union, the less of what a few years ago was called by microscopists inodular tis- sue, the less will be the probability of this veiy troublesome and intractable disease. Quite recently it has occurred to me to develop another and I think much greater advantage of the oblique section of the skin, namely, the avoidance of suppuration, and the obtaining of very prompt and firm union between the cut surfaces. The rationale of this advantage can be easily seen. We have a close apposition