Plastic surgery; its principles and practice . c —i. Note the deep cavitycovered with granulations and the surrounding skin being drawn in over the orbital mar-gins. This caused intense discomfort. The problem of checking the pull of the skin intothe orbital cavity and at the same time filling the cavity had to be considered. A flapfrom the neck or forehead could have been used, but this procedure entailed a disfiguringscar which should always be avoided if possible. It was decided to attempt to fill the cavityby means of a pedunculated flap from the abdomen with a double transfer. 2.
Plastic surgery; its principles and practice . c —i. Note the deep cavitycovered with granulations and the surrounding skin being drawn in over the orbital mar-gins. This caused intense discomfort. The problem of checking the pull of the skin intothe orbital cavity and at the same time filling the cavity had to be considered. A flapfrom the neck or forehead could have been used, but this procedure entailed a disfiguringscar which should always be avoided if possible. It was decided to attempt to fill the cavityby means of a pedunculated flap from the abdomen with a double transfer. 2. A flap com-posed of the skin and full thickness of the abdominal fat was implanted into an inci-sion along the ulna side of the hand. After two weeks the pedicle was cut and the resultis shown in the photograph. Two weeks later, during which time all ill-nourished portionswere removed, the eye defect was prepared and, after proper shaping, the flap was im-planted into the orbital cavity, and about two-thirds of the skin margin was Fig. 368.—Exenteration of the orbit, contimied.— i. After ten days the flap was cutaway from the hand, and the remaining portion was fitted into position. The photographwas taken one week after this and shows some of the stitches in the portion last Taken one j^ear later. There has been shrinkage of the fat, but the skin is soft andmovable and all tendency to puckering and drawing in of the face skin has been eliminated,and there is no discomfort. The age of the patient contraindicated any attempt to formlids and prepare a socket for an artificial eye. has been established from the palm to the flap, to amputate from theabdominal wall, then shape the fat and transfer the flap on the handto the defect in the orbit, which has been prepared to receive it, and SURGERY OF THE EYELIDS 3^5 suture the skin edges to the surrounding skin. In due time (from ten tofourteen days) the flap is cut away from the hand and the rest of thedefe
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgeryplastic, booky
