Plastic surgery; its principles and practice . sed. The defects left by raisingthe flaps may be sutured. The use of this method by Fricke, Blasius, Hasner, Richet, Landolt,and others, will not be described in detail, the plates being sufiicientlyexplanatory. 4. Pedunculated Flaps from Distant Parts.—Eyelids ha\e beenformed from pedunculated flaps from the arm (Berger and others),and neck (Syndacker-Morax, and others). By the use of these flaps 378 PLASTIC SURGERY scarring of the face is avoided and normal tissue is secured in thosecases in which the face is covered with scar. Pedunculated flap
Plastic surgery; its principles and practice . sed. The defects left by raisingthe flaps may be sutured. The use of this method by Fricke, Blasius, Hasner, Richet, Landolt,and others, will not be described in detail, the plates being sufiicientlyexplanatory. 4. Pedunculated Flaps from Distant Parts.—Eyelids ha\e beenformed from pedunculated flaps from the arm (Berger and others),and neck (Syndacker-Morax, and others). By the use of these flaps 378 PLASTIC SURGERY scarring of the face is avoided and normal tissue is secured in thosecases in which the face is covered with scar. Pedunculated flaps of this type may be used for the relief of ectro-pion, when the tarsal cartilage and conjunctiva are present, and also forthe restoration of the lids. In the latter case it is essential that theflaps be lined with epithelium to prevent subsequent adhesion and con-tracture. This can be accomplished either by turning the end of theflap on itself (which makes a thick and clumsy flap), or by preliminarygrafting of the raw surface of the Fig. 363.—Syndacker-Morax method of utilizing a pedunculated flap from the neck forthe restoration of one (Syndacker) or both (Morax) eyelids (Beard, in Wood).—i. Theoutline of the flap with its base beneath the ears to be raised from the skin over the sterno-cleidomastoid muscle. It should be sufficiently long to cover the lid defect without ten-sion. Note the defect nearly encircling the eye. 2. The flap raised and sutured into theupper lid defect. The neck wound is sutured. 3. The pedicle of the flap is severed aftertwo weeks, and the unattached portion of the flap is adjusted and sutured into the restof the defect. The ideal lining of these flaps would be mucous membrane, but asyet no satisfactory technic has been developed for its use. It is possiblethat the application of a flap of buccal or vaginal mucosa placed in apocket in some such way as is described in Gibsons operation, mightbe worth trying. In any case, the result of th
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