Plastic surgery; its principles and practice . Where the main portion of the defectis in the skin, but in addition there is a smallopening into the buccal cavity, unthout con-tracture of the jaw.—This may be treated(a) by freshening the edges and drawingthe wound together with sutures if thedefect is small; (b) by sliding flaps; (c)with flaps from adjacent tissue (Indianmethod); (d) with flaps from a distantpart (Italian method). (3) Where there is an extensive defect in-volving the entire thickness of the cheek, itmust be filled with flaps having epitheliumon both sides; from the neck covered
Plastic surgery; its principles and practice . Where the main portion of the defectis in the skin, but in addition there is a smallopening into the buccal cavity, unthout con-tracture of the jaw.—This may be treated(a) by freshening the edges and drawingthe wound together with sutures if thedefect is small; (b) by sliding flaps; (c)with flaps from adjacent tissue (Indianmethod); (d) with flaps from a distantpart (Italian method). (3) Where there is an extensive defect in-volving the entire thickness of the cheek, itmust be filled with flaps having epitheliumon both sides; from the neck covered by a cheek flap; from the cheekcovered by a neck or scalp flap; from the neck covered by a flap fromthe arm; from the arm. neck, or chest, by folding a flap on itself; fromthe arm. neck, or chest, after grafting the under surface of the flap be-fore transplantation. Various other combinations may be used. Extensive defects may be divided into two general groups: (i)Those in w^hich restoration is feasible immediately after the destruc- 565. Fig. 660.—Fatal burn of thecheek.—A third degree burn ofthis size would not ordinarily befatal. Marked symptomsoccurred. The situation anddepth of the burn contraindicatedcomplete excision, which couldhave been done on almost anyother part of the body. 566 PLASTIC SURGERY tive operation or injury. (2) Those due to ulceration of some soft part,or extensive destruction, in which the restoration must necessarily bedelayed until healing is complete. With this group there is nearlyalways associated contracture of the jaws due to dense scar which mayinvolve the surrounding skin, muscle and mucous membrane—a con-tracture which is very difhcult to overcome. In long-standing casesatrophy of the mandible is also usually found. If the gap is small, and there is plenty of normal skin, but the jawsare locked, the cheek must be lined according to the method the gap is large, the surrounding skin scant, and the jaws are locked,in
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