Plastic surgery; its principles and practice . trated the chest wall. The case wasfound to be inoperable. and are very useful in hastening the healing of extensive wounds. Bytheir aid contractures may in many instances be prevented; in others,even if a certain amount of contracture follows, it is much less difficultto correct than if healing has taken place unassisted. On wounds away from joints any of the types of skin grafts may beused with satisfactory results. If the loss of substance is over a joint,for instance in the cubital or popliteal spaces, we must select the type SURGERY OF THE EX
Plastic surgery; its principles and practice . trated the chest wall. The case wasfound to be inoperable. and are very useful in hastening the healing of extensive wounds. Bytheir aid contractures may in many instances be prevented; in others,even if a certain amount of contracture follows, it is much less difficultto correct than if healing has taken place unassisted. On wounds away from joints any of the types of skin grafts may beused with satisfactory results. If the loss of substance is over a joint,for instance in the cubital or popliteal spaces, we must select the type SURGERY OF THE EXTREMITIES 641 of graft under which contracture is least likely to occur. Ollier-Thierschgrafts are often used, but as contracture frequently takes place beneatha graft of this type, it is more satisfactory to use whole-thickness skinin these situations. I have seen some good results with small deepgrafts around the elbow;, wrist and knee, but this type is not to berecommended in these situations, as contracture often takes placeafter Fig. ;46.—vSurg. Xo. 29316), continued.—Posterior view of hemangioma involving the upper extremity. Other Methods.—Occasionally gliding flaps may be used (Frenchmethod). The Indian method is suitable in certain situations, butfrequently the condition of the surrounding tissue and the situationof the wound contraindicates the use of a flap from neighboringtissue. The procedure of choice, when a thick pad of fat and skin is re-quired under which no contracture will occur, is the flap from a distantpart (Italian method). 642 PLASTIC SURGERY TREATMENT OF VICIOUS CICATRICES Excision, or Division, with Skin —After cicatrices haveformed the best method of treatment is to excise, if possible, all of thecontracting scar. If the defect left by this excision is not in theneighborhood of a joint, it may be successfully treated with any of thetypes of skin grafts. On the other hand, if the defect is close to ajoint, my experience has
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