Plastic surgery; its principles and practice . ural folds. A number of these patients have come under my care, and for along time they gave me much trouble. After I had used many methodswith little success, it occurred to me to tr\ relaxation incisions and tograft the defects thus made. SCARS AND KELOIDS 209 Technic.—Preferably the area should be entirely healed beforethe incisions are made, but in some instances when the healing of thesuperficial ulcers has been extremely sluggish, I have not waited forcomplete healing, but have operated as soon as the granulations havebeen brought into a hea
Plastic surgery; its principles and practice . ural folds. A number of these patients have come under my care, and for along time they gave me much trouble. After I had used many methodswith little success, it occurred to me to tr\ relaxation incisions and tograft the defects thus made. SCARS AND KELOIDS 209 Technic.—Preferably the area should be entirely healed beforethe incisions are made, but in some instances when the healing of thesuperficial ulcers has been extremely sluggish, I have not waited forcomplete healing, but have operated as soon as the granulations havebeen brought into a healthy condition. In preparation for operationin the unhealed cases, after the granulations are healthy, the part is putup in a dressing kept wet with normal salt solution for 24 hours. Thegranulations are then painted with tincture of iodin, and the surround-ing scar is cleaned with ether and alcohol. In many cases the relaxation incisions can be made after infiltrationwith a local anesthetic such as Schleichs solution, or per cent novo-. FiG. 154.—Scars of cheek, eyelids and forehead, following an accident three monthspreviously.—i and 2. Show the condition on admission to the hospital. The eyelidscannot be closed. 3. Result of excision of scars on the forehead and cheek, and of re-adjusting the lid margins. Taken one year after operation. cain. In other instances a general anesthetic is advisable, especiallyif large immediate OlHer-Thiersch grafts are to be used to cover thedefect. On an arm or leg long incisions should be made, parallel with thelong axis of the part, down to the deep fascia; or to healthy tissue, ifthe destruction has been deeper than the fascia. Three relaxationincisions are usually sufl&cient for a limb, and they result in gapingwounds. The immediate spread of each relaxation incision varieswith the tightness of the scar. In some instances it is as much as from 14 2IO PLASTIC SURGERY 6. to 8. cm. ( to 3I5 inches) at the center of the incision.
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