Plastic surgery; its principles and practice . non-toxic;it is easily metabolized, and excreted in an innocuous form; it can besterilized by boiling and is comparatively inexpensive. General anesthesia must be used in many instances. Thechoice of anesthetic must depend on circumstances, although ether isusually to be preferred, given by the drop method, or in selected casesby the intratracheal route. Combination anesthesia may be used withadvantage in some long cases; a portion of the work being done underlocal anesthesia, for instance in securing a cartilage graft, and theremainder under a ge
Plastic surgery; its principles and practice . non-toxic;it is easily metabolized, and excreted in an innocuous form; it can besterilized by boiling and is comparatively inexpensive. General anesthesia must be used in many instances. Thechoice of anesthetic must depend on circumstances, although ether isusually to be preferred, given by the drop method, or in selected casesby the intratracheal route. Combination anesthesia may be used withadvantage in some long cases; a portion of the work being done underlocal anesthesia, for instance in securing a cartilage graft, and theremainder under a general anesthetic. General anesthesia with nitrous-oxide-oxygen, and ethyl chloride,may be used in suitable cases. Where a general anesthetic is used,especially in face and mouth cases, it is essential that the anesthetistshould be an ^ ^ For more detailed information on local anesthesia, the reader is referred to LocalAnesthesia by Braun & Shields, 1914, and Local Anesthesia, 2d. ed., 1918, by C. GENERAL CONSIDERATIONS 25. Fig. 44. Fig. 45. Figs. 44 and 45.—Langers lines of cleavage of the skin. {Modified from Kocher.)In all operations in which a narrow inconspicuous scar is an object, the incision shouldbe made parallel to the tension lines. If this is done there will be little gaping of the the incision is made across these lines wide gaping will occur and a more conspicuousscar will result. 26 PLASTIC SURGERY INCISIONS AND METHODS OF CLOSURE The incisions used in plastic surgery should as far as possible bemade parallel to the tension planes of the skin (Figs. 44 and 45). Inmany cases curved incisions will accomplish more than straight ones. On the face the natural lines should be followed, and if this is notpossible, the incision should be made parallel to these lines and notacross them.
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