Plastic surgery; its principles and practice . rder of the double-faced flap is subsequently split and the margins sutured into the defect,thus completely closing it. flap should be long enough when raised to reach the most distant pointin the defect without tension, and wide enough to fill the gap. Itmust be remembered that flaps from the neck contract a great deal SURGERY OF THE CHEEK 577 and allowance must be made fur this shrinkage. After being raised,the flap is turned over, skin surface inside, and its free end is carefullysutured to the loosened mucous membrane at the margins of thedefe
Plastic surgery; its principles and practice . rder of the double-faced flap is subsequently split and the margins sutured into the defect,thus completely closing it. flap should be long enough when raised to reach the most distant pointin the defect without tension, and wide enough to fill the gap. Itmust be remembered that flaps from the neck contract a great deal SURGERY OF THE CHEEK 577 and allowance must be made fur this shrinkage. After being raised,the flap is turned over, skin surface inside, and its free end is carefullysutured to the loosened mucous membrane at the margins of thedefect, except in the portion under the pedicle (Fig. 677). It can be seen from this that the pedicle bridges over an area ofnormal skin, and the skin surfaces should be kept apart with neck wound is closed, as far as may be, with sutures. Second Stage.—Three weeks later the pedicle is cut. The exposedraw surfaces having been freshened the posterior portion of the flap isturned forward and sutured, thus covering the raw surface of the. Fig. 678.—Method of closing cheek defect with flap from the neck {Blair).—i. Flapraised from the neck and folded on itself. 2. After healing is complete the flap is shiftedinto the cheek defect and its sides sutured to the freshened edges. 2. Two to three weekslater the pedicle is cut, the upper end of the flap is opened and both extremities of the flapare fitted into the defect. Note the relaxation incision on the neck. portion previously implanted. This leaves a sinus opening into themouth at the posterior edge. Third Stage.—Two or three weeks later the flap is opened at itspoint of reflexion (posterior margin) and, after preparation of the edge ofthe defect, the inner layer of the flap is sutured to mucous membraneand the outer to the skin. Several secondary shaping operations maybe necessary. Hahns Operation.—This operation diflers from that of Israel onlyin that the flap is obtained from the skin of the chest (down to thenipp
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