Cases of deformity of various kinds, successfully treated by plastic operations / by Thomas D. Mütter.

  • Mütter, Thomas D. (Thomas Dent), 1811-1859.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: Cases of deformity of various kinds, successfully treated by plastic operations / by Thomas D. Mütter. 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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    incision, about two inches long, is carried from either angle of the mouth outwards, through the cheeks, so as to throw the mouth widely open. The length of these incisions must be regulated according to the width of the mouth; or, as a general rule, the combined incisions must somewhat exceed in length the breadth of the upper lip. From the outer point of each of these, another incision is next carried obliquely downwards and towards the median line ; the section in this case likewise extending through the whole thickness of the cheek. Thus, by means of the first operation for paring the cicatrix, and by the succeeding horizontal and vertical in- cisions, a flap will be prepared on either side to replace the defective lip ; this flap is of a quadrangular form, and main- tains a connexion of more than an inch wide with the soft parts covering the tissue of the lower jaw. It may be use- ful further to separate the mucous membrane at its attach- ment to the gums, to allow of the more ready traction of the flaps.” The severe injury inflicted on the facial nerve, the large arteries and veins, and possibly the parotid duct, has ren- dered this operation anything but popular. Yet, as already remarked, it has been performed with success by several, among whom is my colleague, Professor Pancoast. Operation of Liston.—Any opinion of this truly great surgeon is always deserving the utmost respect and attention, and, although my own observations lead me to a different conclusion in relation to the best mode of restoring a lip, 1 cannot for a moment hesitate to advise the repetition, when- ever practicable, of his method, (a modification of the Indian,) by all who desire experience in this department of our art. It consists in first removing the diseased mass by a hori- zontal and two perpendicular cuts, or by one curvilinear in shape; and, second, in detaching a flap from the chin and neck, twisting it on its pedicle, placing it in the seat of the original lip, and there retaining it by suture. After adhesion has taken place, the pedicle is divided, and a “wedge-shaped” piece removed, so as tu allow the flap to be laid down 6