The Wisconsin Medical Recorder A Monthly Journal of Medicine and Surgery, Devoted to the Best Interests of the Whole Profession VOL. XI JANUARY, 1908 No 1. Leading Original Articles THE APPLICATION OF CERTAIN PRINCIPLES OF PLASTIC SURGERY IN CLOSING DEFICIENCIES IN EXPOSED CUTANEOUS SURFACES By Charles C. Miller, M. D., 70 State Street, Chicago, Ill. (Continued from page 386 December Recorder) As mentioned in the preceding article, a deficiency must be looked upon not as to its exact shape, but as to its general outline. In the circle or oval we have figures, which if not too large, may be considered as rough triangles and closed as such. Such closure leaves the same form of scar as the triangle and such may be less conspicuous than drawing the parts together from numerous points. In some cases, by immediate adduction, it is impossible to entirely close the triangle of equal sides, and a small deficiency is left in the center, which is allowed to heal by granulation. The rectangle may be closed by drawing the tissues toward each other from the four points of the figure and the result is a parallel line from each end of which will be two diverging lines, representing the lines of approximation. The rough circle, ellipse or oval may be approximated in the same manner as the rectangle and the results in many cases are better than in those cases where plans outlined previously have been followed. The usual method of closing the oblong ellipse or oval figure is by approximating the long sides of the figure so that the scar which is left is a straight line. In some cases, if this plan is followed, it will not permit of quite as easy an approximation as where the parts are brought in somewhat from each end of the deficiency as well as from the sides. Rhomboidal defects are closed so that the resulting line of approximation is linear and as the result is obtained by increasing the obliquity of the rhomboid, the more oblique it is in the beginning, the easier will be the approximation. The rectangle can be treated in the same manner in many instances so that the scar which is left is merely a linear one. In altering the shape of the rectangle to that of a rhomboid the operator will not forget that the line of sutures can be made to run in two directions, and careful observations of the advantages of one or the other direction should be taken before the deficiency is closed. The ellipse may be closed in the same manner as the rhomboid, but here there is not an obliquity of the line of suture as in the altered rectangle. |