Quarterly report of the Edinburgh Surgical Hospital, from May to August 1829 / [James Syme].

  • Syme, James, 1799-1870
Date:
[1829]
Catalogue details

Licence: Public Domain Mark

Credit: Quarterly report of the Edinburgh Surgical Hospital, from May to August 1829 / [James Syme]. Source: Wellcome Collection.

    67/86 (page 23)
    much of this skin as might be required to complete the septum, and endeavour to unite it at the same time with the edge of the lip. With this view, having dissected off the skin, I removed the projection with cutting-pliers. A profuse hemorrhage then en¬ sued, and rendered some delay necessary ; as the arteries which spouted were lodged in the bone, and consequently could not be tied. When the bleeding had subsided sufficiently, I made the edges of the lip raw, by cutting off a slice from each; and here it may be right to remark, that the success of the operation for hare-lip, so far as the shape of the lip is concerned, depends much on the mode in which this is done. The edges of the malformed lip being always convex, it is plain that if the sur¬ geon cuts a slice of the same thickness from the whole of their surface, when they are brought together, the result will be an angle at the point of union. But if he cuts so as to make the slice thin at the ends and thick where the edge of the lip is most convex, the appearance will be more natural. I then united the edges together, and having reduced the portion of integument procured from the central part to a proper size for completing the septum, fixed it in its place with a suture. The child made no complaint after the operation, and the union was subsequently accomplished, notwithstanding some superficial ulceration, owing to the irritation of the needles, and the strain of the stretched lip; to lessen which, a strip of ad¬ hesive plaster wras applied, so as to draw the cheeks together. There remained, however, a small opening between the lip and septum, over the part of the bone to which the root of the pro¬ jection had adhered. The surface of this was granulating ; and I have no doubt the aperture would either be obliterated, or, at all events, become so small as to occasion hardly any percep¬ tible difference, so soon as the exposed surface of the bone heal¬ ed. The boy’s father being anxious to return home, took him away on the 2d February, before this could be ascertained. My friend, Mr Dewar of Dunfermline, has related and re¬ presented two cases of this disease in the number of this Jour¬ nal for July last. Having, in the first of these, been disap¬ pointed in obtaining union between the edges of the lip when placed together immediately after the removal of the central pro¬ jection, he advises it to be taken away in the first place, so that ail the irritation caused by this part of the operation may have ceased before the uniting process is commenced. rl he only ob¬ jection to this mode of proceeding is the necessity which it oc¬ casions of leaving the septum deficient, owing to the removal of the skin that covers the projection, which might, if dissected