Plastic surgery; its principles and practice . Fig. 687.—Operation for closing a cheek defect (Lauenslein, Annals of Surgery, 1893,57).— I. A indicates the bridge flap which is undermined; B, the hinged flap which is tobe drawn under A. 2. The flap B drawn under A and sutured; D. the raw area, whichshould be grafted. 3. Outline of pedicle C. The lower pedicle of flap A is graduallysevered. The pedicle of flap B is cut, and the double-faced flap A is then shifted to thecheek. lips and are carried across on the opposite cheek a sufficient distanceto loosen the flap freely. Then the flap is shift
Plastic surgery; its principles and practice . Fig. 687.—Operation for closing a cheek defect (Lauenslein, Annals of Surgery, 1893,57).— I. A indicates the bridge flap which is undermined; B, the hinged flap which is tobe drawn under A. 2. The flap B drawn under A and sutured; D. the raw area, whichshould be grafted. 3. Outline of pedicle C. The lower pedicle of flap A is graduallysevered. The pedicle of flap B is cut, and the double-faced flap A is then shifted to thecheek. lips and are carried across on the opposite cheek a sufficient distanceto loosen the flap freely. Then the flap is shifted over and sutured tothe margins of the defect in layers. The mouth is now much dis-placed, but after healing is complete it is returned to its central posi-. FiG. 688.—Operation for closing a cheek defect (Lerda).^i. The cheek defect. Theincisions through the full thickness of the cheek are indicated by dotted lines. 2 and and cheek of opposite side shifted over to fill the defect. 4. The defect closed andsituation of the mouth changed by shortening the angle on one side, and lengthening onthe other. tion by lengthening the angle away from, and shortening the anglenearest to the defect. This operation is not to be recommended,although it may be used occasionally (Fig. 688). 586 PLASTIC SURGERY Bardenheuers Operation.—This very mutilating procedure shouldbe considered only in unusual and very extensive cases. Two flapsare taken, one from the forehead, with the pedicle above the eye, toline the cheek; the other, or covering flap, is taken from the side of theneck with the pedicle at the margin of the lower jaw. The flap whichis utilized to replace the mucous membrane should be hairless. Thepedicles are divided later, and secondar
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