A manual of operative surgery . involve the deriva-tion of the flap from the neighbouring integuments. Thus, inrepairing defects of the nose the flap may be obtained from the- no OPERATIONS ON HEAD AND NECK [part hi foreheau or cheek. A pedicle is formed, and the flap is drawninto its new position by torsion or gliding. These operations are considered in detail in the section^ onRhinoplasty (page 116). A good example of this method is furnished by the followingoperation for ectropion, a condition frequently met with afterthe cure of lupus of the cheek, etc. The first step consists incutting th
A manual of operative surgery . involve the deriva-tion of the flap from the neighbouring integuments. Thus, inrepairing defects of the nose the flap may be obtained from the- no OPERATIONS ON HEAD AND NECK [part hi foreheau or cheek. A pedicle is formed, and the flap is drawninto its new position by torsion or gliding. These operations are considered in detail in the section^ onRhinoplasty (page 116). A good example of this method is furnished by the followingoperation for ectropion, a condition frequently met with afterthe cure of lupus of the cheek, etc. The first step consists incutting the eyelashes on both lids as short as possible. With avery fine knife the edge of each lid is then pared just within theline of the eyelashes so that the two lids may be sutured curved incision is now made parallel with the edge of theeverted lid, this incision is deepened and enlarged until the lidcan be easily brought up to meet the upper one. Thus a wide,gap is produced, and the two lids are sewn together with fine. |J3 FIG. 241. — FLAP OPERATION FOR ECTROPION OF LOWER LID. 1 Curved incision made below edge of everted lid ; 2, Incision opened out to full extent3, Temporal flap F shaped out ready for suturing in the gap. The eyelids are fixedtogether by a few sutures. silk introduced at three or four points along the lid-edges (Fig. 241).A flap is now shaped from the healthy skin of the temple, theapex of the flap being upwards and its pedicle joining the outerend of the raw surface already prepared (Fig. 241). The flapis made slightly longer and wider than the gap, as it is sure tocontract somewhat. Its shape and borders must be made tocorrespond with those of the gap. After this flap has beencarefully raised down to its narrow pedicle, all bleeding is stoppedby forceps pressure, aided perhaps by fine ligatures. Finallythe flap is swung round and laid in position, its apex is first unitedto the inner end of the gap, and its borders are sutured with thefinest silk
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