. Operative surgery, for students and practitioners . Fig. 42.—Nelaton Opera- Fig. 43.—Incision Con-tion for Incomplete Hare- verted into a Perpendicu-lip. Line of incision. lar, Ready for Suture. After Malgaigne proposed to close the defect, especially where thedefect is considerable, by making use of flaps in addition to fresh-ening the edges. In his operation the tissue is removed from theangle of the notch only, the second part of the operation consistingin the formation of flaps by simply cutting into the substance ofthe lip along either side of the defect, commencing near the angleand cu
. Operative surgery, for students and practitioners . Fig. 42.—Nelaton Opera- Fig. 43.—Incision Con-tion for Incomplete Hare- verted into a Perpendicu-lip. Line of incision. lar, Ready for Suture. After Malgaigne proposed to close the defect, especially where thedefect is considerable, by making use of flaps in addition to fresh-ening the edges. In his operation the tissue is removed from theangle of the notch only, the second part of the operation consistingin the formation of flaps by simply cutting into the substance ofthe lip along either side of the defect, commencing near the angleand cutting toward the red border of the lip. The base of the flap. Fig. 45.—Malgaigne Oper- Fig. 46.—Flaps Turned ation for Incomplete Hare- Down, Ready for Paring and formationof flaps. trarrmrrff Fig. 47.—Result AfterParts have been Sutured. should be no thicker than the red of the lip; otherwise it is verydifficult to turn it down. The tongues of tissue thus marked outare turned down and sutured together, with the result that the cleftis not only filled in, but a little tongue of tissue is left projectingbeyond the free line of the lip to allow for future retraction. The objection to this operation is that, on account of the con-siderable torsion to which the flaps are subjected, their nourishmentis uncertain and they may become gangrenous, especially in veryyoung children. OPERATIONS FOR HARELIP, CLEFT PALATE, ETC. 107 Mieaults operation is an improvement on Malgaignes. Onlyone flap is made, and that is taken from the edge of the lateralsegment. The flap which is thus formed is sutured to the freshenededge of the middle segment.
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