PLASTIC AND COSMETIC SURGERY
[Illustration: “FATHER OF PLASTIC SURGERY.”]
PLASTIC AND
COSMETIC SURGERY
BY
FREDERICK STRANGE KOLLE, M.D.
FELLOW OF NEW YORK ACADEMY OF MEDICINE; MEMBER OF DEUTSCHE
MEDEZINISCHE GESELLSCHAFT, N. Y., KINGS COUNTY HOSPITAL ALUMNI
SOCIETY, AUTHORS’ COMMITTEE AMERICAN HEALTH LEAGUE, PHYSICIANS’
LEGISLATURE LEAGUE ETC.; AUTHOR OF “THE X-RAYS: THEIR
PRODUCTION AND APPLICATION,” “MEDICO-SURGICAL RADIOGRAPHY,”
“SUBCUTANEOUS HYDROCARBON PROTHESES,” ETC.
_WITH ONE COLORED PLATE AND FIVE HUNDRED AND
TWENTY-TWO ILLUSTRATIONS IN TEXT_
[Illustration]
NEW YORK AND LONDON
D. APPLETON AND COMPANY
1911
COPYRIGHT, 1911, BY
D. APPLETON AND COMPANY
PRINTED AT THE APPLETON PRESS,
NEW YORK, U. S. A.
TO
ALPHONZO BENJAMIN BOWERS
WHO KINDLED THE FIRE OF MY AMBITION
AND KEPT IT BURNING BY
HIS INTEREST AND UNTIRING APPRECIATION
THIS WORK IS
WITH HEARTFELT GRATITUDE
INSCRIBED
PREFACE
The object of the author has been to place before the profession a
thoroughly practical and concise treatise on plastic and cosmetic
surgery. The importance of this branch of practice is at the present
time undeniable, yet the literature on this subject is widely scattered
and scanty. It consists mostly of small, detached papers or reports
in different countries, with an occasional reference in text-books on
general surgery.
The author feels, from the numerous inquiries made him by physicians from
many parts of the world concerning methods herein described, that there
is now an actual need for an authoritative work on this subject.
Great care has been taken to select the best matter and to present
it with comprehensive illustrations every physician can readily and
confidently refer to.
Skin-grafting has been particularly gone into, as well as electrolysis
as applied to dermatology, with information as to the construction and
scientific use of apparatus involved.
To the whole has been added the practical experience and criticism of
the author, who has devoted many years to the scientific and faithful
advancement of this specialty.
FREDERICK STRANGE KOLLE.
12 EAST THIRTY-FIRST STREET, NEW YORK CITY.
CONTENTS
PAGE
CHAPTER I
HISTORICAL
Historical 1
CHAPTER II
REQUIREMENTS FOR OPERATING
The operating room: The walls; The floors; Skylight;
Disinfection; Instrument cabinet; Operating table; Instrument
table; Irrigator—Care of instruments—Preparation of the surgeon
and assistants: Care of the hands; Gowns—Preparing the patient:
General preparation; Preparation of the operative field 9
CHAPTER III
REQUIREMENTS DURING OPERATION
Sponges and sponging—Sterilization of dressings: Wallace
sterilizer; Sprague sterilizer; Sterilizing plant; Dressing
cases; Waste cans—Sutures and sterilization: Silkworm gut and
silk; Catgut 22
CHAPTER IV
PREFERRED ANTISEPTICS
Antiseptic solutions—Antiseptic powders 34
CHAPTER V
WOUND DRESSINGS
Sutured wounds—Sutureless coaptation—Granulation—Changing
dressings—Wounds of the mucous membrane—Pedunculated
flaps—Foreign bodies 43
CHAPTER VI
SECONDARY ANTISEPSIS
Septicemia following wound infection—Gangrene—Erysipelatous
infection 52
CHAPTER VII
ANESTHETICS
General anesthesia: Preparation for general anesthesia;
Chloroform; Ether; Combined anesthesia; Nitrous oxid; Ethyl
bromid; Ethyl chlorid—Local anesthesia: Ethyl chlorid; Cocain;
Beta eucain; Liquid air; Stovain 58
CHAPTER VIII
PRINCIPLES OF PLASTIC SURGERY
Incisions—Sutures—Needles—Needle holders—Methods in plastic
operations: Stretching method; Sliding method; Twisting
method; Implantation of pedunculated flaps by bridging;
Transplantation of nonpedunculated flaps or skin-grafting;
Autodermic skin-grafting; Heterodermic skin-grafting;
Zoödermic skin-grafting—Mucous-membrane-grafting—Bone-
grafting—Hair-transplantation 76
CHAPTER IX
BLEPHAROPLASTY
Ectropion: Partial ectropion;
Complete ectropion; Ectropion of both
lids—Epicanthus—Canthoplasty—Ptosis—Ankyloblepharon—Wrinkled
eyelids—Xanthelasma palpebrarum 103
CHAPTER X
OTOPLASTY
Restoration of the auricle—Auricular
protheses—Coloboma—Malformation of the lobule: Enlargement of
the lobule; Attachment of the lobe—Malformation of the auricle:
Microtia—Auricular Appendages—Polyotia—Malposition of the
auricle 120
CHAPTER XI
CHEILOPLASTY
Harelip: Classification of harelip deformities; The operative
correction of harelip; Of unilateral labial cleft; Of
congenital bilateral labial cleft; Post-operative treatment of
harelip—Superior cheiloplasty: Classification of deformities
of the upper lip; Operative correction of deformities of the
upper lip—Inferior cheiloplasty—Labial deficiency—Labial
ectropion—Labial entropion—Vermilion deficiency 145
CHAPTER XII
STOMATOPLASTY
The correction of macrostoma—The correction of microstoma 192
CHAPTER XIII
MELOPLASTY
Small and medium defects—Large defects—Employment of protheses 198
CHAPTER XIV
SUBCUTANEOUS HYDROCARBON PROTHESES
Indications—Precautions—The advantage of the method—Untoward
results: Intoxication; Reaction; Infection; Necrosis;
Sloughing; Sloughing due to pressure; Subinjection;
Hyperinjection; Air embolism; Paraffin embolism; Primary
diffusion or extension of paraffin; Interference with
muscular action of the wings of the nose; Escape of paraffin
after withdrawal of needle; Solidification of paraffin in
needle; Absorption or disintegration of the paraffin; The
difficulty of procuring paraffin with proper melting point;
Hypersensitiveness of skin; Redness of the skin; Secondary
diffusion of the injected mass; Hyperplasia of the connective
tissue following the organization of injected matter; Yellow
appearance and thickening of the skin after organization
of the injected mass has taken place; The breaking down of
tissue and resultant abscess due to the pressure of the
injected mass upon the adjacent tissue after the injection has
become organized—The proper instruments for the subcutaneous
injection of hydrocarbon protheses—Preparation of the site of
operation—Preparation of the instruments for operation—The
practical technique—Specific classification for the employment
and indication of hydrocarbon protheses about the face—Specific
classification for the employment and indication of hydrocarbon
protheses about the shoulders, etc.—Specific technique for the
correction of regional deformities about the face: Transverse
depressions; Deficient or receding forehead; Unilateral
deficiency; Interciliary furrow; Temporal muscular deficiency;
Deformities of the nose; Deformities about the mouth;
Deformities about the cheeks; Deformities about the orbit;
Deformities about the chin; Deformities about the ear—Specific
technique for the correction of deformities about the shoulders 209
CHAPTER XV
RHINOPLASTY
The causes of nasal destruction—Classification of
deformities—Surgical technique—Protheses—Nasal replanting—Nasal
transplanting—Total rhinoplasty: Pedunculated flap method; The
Indian or Hindu method; The French method; The Italian method;
The combined flap method; Organic support of nasal flaps;
Periostitic supports; Osteoperiostitic supports; Cartilaginous
support of flap—Partial rhinoplasty; Restoration of base of
nose; Restoration of lobule and alæ; Restoration of the alæ;
Restoration of nasal lobule; Restoration of subseptum 339
CHAPTER XVI
COSMETIC RHINOPLASTY
Angular nasal deformity—Correction of elevated
lobule—Correction of bulbous lobule—Angular excision to
correct lobule—Correction of malformations about nasal
lobule—Deficiency of nasal lobule—Correction of widened base
of nose—Reduction of thickness of alæ—Correction of nasal
deviation—Undue prominence of nasal process of the superior
maxillary 448
CHAPTER XVII
ELECTROLYSIS IN DERMATOLOGY
The electric battery—The voltage or electromotive force—Cell
selector—Milliampèremeter—The electric current—Portable
batteries—Electrodes—Removal of superfluous hair—Removal
of moles or other facial growths—Telangiectasis—Removal of
nævi—Removal of tattoo marks—The treatment of scars 470
CHAPTER XVIII
CASE RECORDING METHODS
Photographs—Stencil record—The rubber stamp—The plaster
cast—Preparation of photographs 491
LIST OF ILLUSTRATIONS
=Transcriber’s Note:= Some illustrations have been moved to where they fit
best with the surrounding text.
FIG. PAGE
A. Cornelius Celsus (“Father of Plastic Surgery”). _Frontispiece_
HISTORICAL
1.—Celsus incision for restoration of defect 2
2.—Celsus incision to relieve tension 2
REQUIREMENTS FOR OPERATING
3.—Formaldehyd disinfecting apparatus 11
4.—Instrument cabinet 12
5.—Operating table 13
6.—Instrument table 14
7.—Irrigator 15
8.—Instrument sterilizer 16
9.—Aseptic washstand 17
10.—Von Bergman operating gown 19
11.—Triffe rubber apron 19
REQUIREMENTS DURING OPERATION
12.—Basins and rack 23
13.—Willy Meyer sterilizer 25
14.—Wallace sterilizer 25
15.—Sprague type of sterilizer 26
16.—Sterilizing plant 28
17.—Dressing case 29
18.—Combination dressing case and table 29
19.—Waste pail 30
20.—Clark Kumol apparatus 32
WOUND DRESSING
21, 22.—Plaster sutures 46
23, 24.—Angular plaster sutures 46
SECONDARY ANTISEPSIS
25.—Walcher dressing forceps 55
26.—Toothed seizing forceps 55
ANESTHETICS
27.—Schimmelbusch dropping bottle 60
28.—Esmarch dropping bottle 60
29.—Schimmelbusch folding mask 61
30.—Esmarch inhaler 61
31.—Allis inhaler 65
32.—Fowler inhaler 65
33.—Juillard mask 66
34.—Simplex syringe 72
35.—Kolle improved Pravaz syringe 72
36.—“Sub-Q” syringe 72
PRINCIPLES OF PLASTIC SURGERY
37.—⅝ circle Haagedorn needles 77
38.—Crescent curve Haagedorn needles 77
39.—Kersten-Mathieu needle holder 78
40.—Haagedorn needle holder 78
41.—Pozzi-Haagedorn needle holder 78
42.—Weber-Haagedorn needle holder 78
43.—Needleholder with suture carrier 78
44.—Celsus skin incisions 80
44 _a_.—Celsus relieving incisions 80
45.—Rhomboid excision 80
46.—Union of rhomboid excision 80
47.—Oblong excision 81
48.—Coaptation of wound 81
49.—Bitriangular excision 81
50.—Linear coaptation 81
51.—Triangular excision 81
52.—Coaptation of wound 81
53.—Triangular excision with relieving incisions 82
54.—Coaptation of wound 82
55.—Square excision 82
56.—Coaptation of wound 82
57.—Square excision 82
58.—Coaptation of flaps 82
59.—Triangular excision 83
60.—Coaptation of flap 83
61.—Triangular excision 83
62.—Coaptation of flaps 83
63.—Triangular excision 83
64.—Arrangement of flaps 83
65.—Double triangular excision 84
66.—Coaptation of wound 84
67.—Tri-triangular excision 84
68.—Coaptation of wound 84
69.—Rectangular-bitriangular excision 84
70.—Coaptation of wound 84
71.—Weber excision method 85
72.—Coaptation of flaps 85
73.—Elliptical excision 85
74.—Coaptation of flaps 85
75.—Triangular excision 86
76.—Coaptation of flaps 86
77.—Triangular excision 86
78.—Coaptation of flaps 86
79.—Lentenner method of excision 86
80.—Coaptation of flap 86
81.—Burns method of excision 87
82.—Coaptation of flaps 87
83.—Tagliacozza harness 87
84.—Smith skin-grafting scissors 89
85.—Thiersch skin-grafting razor 93
86.—Thiersch folding razor 93
87.—Method of cutting Thiersch graft 94
88.—Method of placing Thiersch graft 95
BLEPHAROPLASTY
89.—Correction of ectropion, Dieffenbach method 104
90 _a_ and _b_.—Correction of partial ectropion (author’s case) 104
91, 92.—Complete ectropion, Dieffenbach method 106
93, 94.—Complete ectropion, Wolfe method 107
95, 96.—Complete ectropion, Fricke method 108
97, 98.—Complete ectropion, Ammon-Von Langenbeck method 109
99, 100.—Complete ectropion, Dieffenbach-Serre method 110
101, 102, 103.—Complete ectropion, Tripier method 111
104, 105.—Complete ectropion, Von Artha method 112
106, 107.—Epicanthus, Bull method 113
108.—Probe-pointer angular scissors 114
109, 110, 111.—External canthoplasty 115
112, 113.—Blepharoplastics, author’s method 116
114.—Curved eye scissors 117
OTOPLASTY
115.—Partial restoration of the auricle 124
116.—Correction of lobular defect 126
117.—Coaptation of wound 126
118, 119.—Greene method correcting coloboma 126
120.—Noyes’s clamp 127
121, 122.—Correction of attached lobe 128
123.—Restoration of auricle, Szymanowski method 129
124.—Auricular stump for attachment of artificial ear 130
125.—Auricular prothesis 130
126.—Auricular prothesis applied to stump 131
127.—Anterior view of auricular prothesis 131
128.—Posterior view of auricular prothesis 131
129, 130, 131.—Schwartze method of correction of macrotia 134
132, 133.—Parkhill method of correction of macrotia 135
134, 135.—Author’s method of correction of macrotia 137
136, 137.—Author’s method of correction of macrotia 137
138.—Monks’ method of correction of malposed ear 139
139, 140.—Author’s method of correction of malposed ear 140
141, 142.—Correction of malposed auricles, author’s case
(anterior view) 142
143, 144.—Posterior view of replaced auricles 143
CHEILOPLASTY
145.—Burchardt compression forceps 145
146.—Beinl harelip clamp 145
147.—Median cleft, Siegel’s case 147
148.—Median cleft with rhinophyma, Trendelenburg’s case 147
149, 150, 151.—Types of unilateral labial cleft 148
152.—Unilateral facial cleft, Hasselmann 149
153.—Bilateral facial cleft, Guersant 149
154.—Buccal fissure with macrostoma 150
155, 156, 157.—Harelip correction, Nélaton method 152
158, 159.—Harelip correction, Fillebrown method 153
160, 161, 162.—Harelip correction, Von Langenbeck-Wolff-Sedillot
method 153
163, 164, 165.—Harelip correction, Malgaigne method 154
166, 167.—Harelip correction, Gräfe method 154
168, 169, 170.—Harelip correction, Mirault method 155
171, 172, 173.—Harelip correction, Giralde method 155
174, 175, 176.—Harelip correction, König method 156
177, 178, 179.—Harelip correction, Maas method 156
180, 181, 182.—Harelip correction, Haagedorn method 157
183, 184, 185.—Harelip correction, Dieffenbach method 157
186, 187.—Correction bilateral cleft, Von Esmarch method 159
188, 189, 190.—Correction bilateral cleft, Maas method 159
191, 192, 193.—Correction bilateral cleft, Haagedorn method 160
194, 195, 196.—Correction bilateral cleft, Simon method 160
197.—Hainsley cheek compressor 161
198, 199.—Superior cheiloplasty, Bruns method 164
200, 201.—Superior cheiloplasty, Sedillot method 165
202.—Superior cheiloplasty, Buck method 165
203, 204, 205.—Superior cheiloplasty, Estlander method 166
206, 207.—Inferior cheiloplasty, Richerand method 169
208, 209.—Extirpation of vermilion border 169
210, 211.—Inferior cheiloplasty, Celsus method with additional
incisions 170
212, 213.—Inferior cheiloplasty, Estlander method 171
214, 215.—Inferior cheiloplasty, Bruns method 172
216, 217.—Inferior cheiloplasty, Buck method 172
218, 219.—Inferior cheiloplasty, Dieffenbach method 173
220, 221.—Inferior cheiloplasty, Jäsche method 174
222, 223.—Inferior cheiloplasty, Trendelenburg method 174
224, 225.—Inferior cheiloplasty, Bruns method 175
226, 227.—Inferior cheiloplasty, Bruns bilateral method 175
228, 229, 230.—Inferior cheiloplasty, Buchanan method 176
231, 232.—Inferior cheiloplasty, Syme method 177
233, 234.—Inferior cheiloplasty, Blasius method 178
235, 236.—Inferior cheiloplasty, Bürow method 178
237, 238.—Inferior cheiloplasty, von Langenbeck 179
239, 240.—Inferior cheiloplasty, Morgan method 180
241, 242.—Inferior cheiloplasty, Zeis method 181
243, 244.—Inferior cheiloplasty, Delpech method 182
245, 246.—Inferior cheiloplasty, Teale method 185
247, 248.—Labial ectropion, author’s method 187
249, 250.—Labial ectropion, author’s method 188
STOMATOPLASTY
251, 252.—Correction of Macrostoma, Dieffenbach-Von Langenbeck
method 193
253, 254.—Correction of Macrostoma, author’s method 195
255, 256.—Correction of Microstoma, Dieffenbach method 196
257.—Artificial mouth, Heuter 196
MELOPLASTY
258, 259.—Meloplasty, Serre method 199
260, 261.—Correction of angle of mouth 200
262, 263.—Correction of extensive angle of mouth 200
264, 265.—Meloplasty, Kraske method 201
266, 267, 268.—Meloplasty, Israel method 202
269, 270.—Meloplasty, Bardenheuer 202
271, 272, 273, 274.—Meloplasty, Bardenheuer 203
275, 276, 277, 278.—Meloplasty, Bardenheuer 204
279, 280.—Meloplasty, Staffel 205
281.—Cheek prothesis after removal of sarcoma, Martin 206
282.—Prothesis applied to face 207
SUBCUTANEOUS HYDROCARBON PROTHESES
283.—Circulation of the head (author) _Facing_ 210
284.—Eckstein insulated syringe 232
285.—Quinlan paraffin heater 232
286.—Author’s electrothermic paraffin heater 244
287.—Smith paraffin heater 246
288 _a_, 288 _b_.—Microphotograph, showing fibromatosis _Facing_ 258
289.—Author’s drop syringe 265
290.—Author’s all-metal syringe 266
291.—Smith’s all-metal syringe 267
292, 293.—Anterior superior third nasal deficiency and
correction thereof 289
294, 295.—Anterior median third nasal deficiency and
correction thereof 292
296, 297.—Anterior inferior third nasal deficiency and
correction thereof 294
298 _a_, 298 _b_.—Anterior superior and inferior third nasal
deficiency and correction thereof 301
299, 300.—Anterior total nasal deficiency and corrections thereof 303
301.—Untoward effect of paraffin injection about lobule and
anterior nasal line 311
302, 303.—Profile view, showing correction of antero-lateral
deficiency about chin 330
304, 305.—Frontal view, showing correction of antero-lateral
deficiency about chin; also correction of deficiency
of cheeks 332
RHINOPLASTY
306.—Deficiency of superior and middle third of nose 342
307.—Post-ulcerative deformity of superior third of nose 342
308.—Loss of right ala, lobule and columna 342
309.—Loss of lobule, inferior septum and columna 342
310.—Ulcerative loss of right median lateral skin of nose 343
311.—Loss of nasal bones, partial dorsum, lobule and septum 343
312.—Destruction of nasal bones with dorsum and lobule intact 343
313.—Total loss of nose 343
314, 315, 316.—Koomas method of rhinoplasty 353
317.—Graefe method of rhinoplasty 353
318, 319, 320, 321.—Delpech method of rhinoplasty 354
322, 323.—Lisfranc method of rhinoplasty 355
324.—Labat method of rhinoplasty 356
325.—Keegan method of rhinoplasty 356
326.—Duberwitsky method of rhinoplasty 357
327.—Dieffenbach method of rhinoplasty 357
328.—Von Ammon method of rhinoplasty 358
329.—Auvert method of rhinoplasty 358
330.—Von Langenbeck method of rhinoplasty 359
331, 332.—Petrali method of rhinoplasty 360
333.—Forque method of rhinoplasty 361
334.—D’Alguie method of rhinoplasty 361
335.—Landreau method of rhinoplasty 361
336.—Von Langenbeck method of rhinoplasty 361
337.—Von Langenbeck method of rhinoplasty 362
338.—Szymanowski method of rhinoplasty 362
339.—Nélaton method of rhinoplasty 365
340.—Heuter method of rhinoplasty 365
341.—Bürow method of rhinoplasty 365
342.—Szymanowski method of rhinoplasty 366
343, 344.—Serre method of rhinoplasty 367
345, 346.—Maisonneuve method of rhinoplasty 369
347, 348, 349.—Dieffenbach arm-flap method 373
350.—Szymanowski arm-flap method 375
351.—Fabrizi arm-flap method 376
352, 353.—Steinthal thoracic flap method 377
354, 355.—Volkman method of rhinoplasty 379
356.—Keegan method of rhinoplasty 380
357, 358.—Verneuil method of rhinoplasty 380
359, 360.—Thiersch method of rhinoplasty 381
361, 362.—Helferich method of rhinoplasty 382
363, 364.—Sedillot method of rhinoplasty 383
365.—Berger arm-flap method 385
366.—Berger retention apparatus 385
367, 368.—Szymanowski rhinoplasty method 386
369.—König rhinoplasty method 391
370.—Von Hacker rhinoplasty method, arrangement of frontal
flap to allow chiseling 392
371.—Von Hacker rhinoplasty method, making osteo-periostic
support 392
372.—Von Hacker rhinoplasty method, bone-lined flap in position 392
373, 374.—Rotter rhinoplastic method 394
375, 376.—Schimmelbusch frontal flap method 395
377, 378.—Helferich rhinoplasty method 397
379, 380, 381.—Krause rhinoplasty method 399
382.—Nélaton rhinoplasty method 400
383.—Nélaton rhinoplasty method, making bony support 400
384.—Nélaton rhinoplasty method, cutting through bony plate 401
385.—Nélaton rhinoplasty method, disposition of frontal flap 401
386.—Israel method, forearm flap 402
387.—Israel method, position of forearm to place flap 403
388.—Nélaton method, outlining frontal flap 407
389.—Nélaton method, locating cartilage strip 408
390.—Nélaton method, excision of cartilage strip 409
391.—Nélaton method, placing of cartilage strip 410
392.—Nélaton method, bringing down frontal flap 411
393.—Nélaton method, placing frontal flap 411
394, 395.—Steinhausen partial rhinoplasty method 412
396, 397.—Neumann partial rhinoplasty method 413
398, 399, 400.—Later Neumann partial rhinoplasty method 415
401.—Bardenheuer method, shape of flap 416
402.—Bardenheuer method, disposition of flap 416
403.—Ollier method first step 417
404.—Ollier method, second step 418
405.—Ollier method, position nasal bone occupies 418
406.—Von Langenbeck method, first step 419
407.—Von Langenbeck method, showing separation and elevation of
nose flaps 419
408.—Nélaton method, first step 421
409.—Nélaton method, making lower nasal flap 421
410.—Nélaton method, forming base of nose 422
411.—Nélaton method, ultimate disposition of flap 422
412.—Bayer-Payr restoration of lobule, first step 425
413.—Bayer-Payr restoration of lobule, disposition of flaps 425
414.—Bayer-Payr restoration of lobule, placing of pedicles
after division 425
415.—Ch. Nélaton method, attachment of forearm flap 426
416.—Ch. Nélaton method, forearm flap in position, lateral flaps 426
417.—Ch. Nélaton method, disposition lateral flaps 426
418.—Denonvillier method, making of flap for ala 428
419.—Denonvillier method, disposition of flap for anterior
pedicle ala 428
420.—Denonvillier method, making of flap for ala, posterior
pedicle 428
421.—Denonvillier method, disposition of flap for ala, posterior
pedicle 428
422, 423.—Mutter method of restoration of ala 429
424, 425.—Von Langenbeck method of restoration of ala 430
426.—Busch method of restoration of ala 430
427.—Dieffenbach method of restoration of ala 431
428.—Dupuytren method of restoration of ala 431
429.—Fritz-Reich method of restoration of ala 431
430, 431, 432, 433.—Sedillot method of restoration of ala 432
434, 435.—Nélaton method of restoration of ala 433
436, 437.—Bonnet method of restoration of ala 434
438, 439.—Weber method of restoration of ala 434
440.—Thompson mucosa flap 435
441, 442.—Thompson method of restoration of ala 435
443, 444.—Blandin method of restoration of ala 436
445, 446.—Von Hacker method of restoration of ala 436
447, 448.—Kolle method of restoration of ala 437
449.—Denonvillier method of restoration of ala 438
450, 451, 452.—Von Hacker method of restoration of ala 439
453.—König method of restoration of ala 440
454, 455.—Kolle method of restoration of ala 441
456, 457.—Kolle method of restoration of lobule 442
458, 459.—Blandin method of restoration of subseptum 444
460, 461.—Dupuytren method of restoration of subseptum 445
462.—Serre method of restoration of subseptum 445
463, 464.—Dieffenbach method of restoration of subseptum 446
465.—Heuter method of restoration of subseptum 446
466.—Szymanowski method of restoration of subseptum 446
467, 468.—Szymanowski method of restoration of subseptum 447
COSMETIC RHINOPLASTY
469 _a_, 469 _b_.—Monk method of correction of angular nose 450
470, 471, 472.—Median nasal incision for angular nose 451
473, 474.—Kolle method of lateral incision for angular nose 452
475, 476.—Kolle chisel set 453
477.—Kolle metal mallet 453
478, 479.—Kolle method of correction of retroussé nose 454
480, 481.—Kolle method of correction of broad lobule 456
482, 483.—Kolle method of correction of elongated lobule 458
484.—Kolle method of correction of elongated lobule and base of
nose after excision 460
485.—Kolle method of correction of elongated lobule base of alæ
and lobule 460
486, 487.—Kolle plaster cast of lobule operation 461
488, 489.—Kolle plaster cast of lobule operation 462
490, 491.—Kolle plaster cast of lobule operation 463
492, 493.—Kolle plaster cast of lobule operation 464
494, 495.—Gensoul method of correcting broad nasal base 465
496, 497.—Kolle method of correction of broad nasal base 465
498, 499.—Linhardt method of reduction of thickened alæ 466
500, 501.—Dieffenbach method of reduction of thickened nose 467
ELECTROLYSIS IN DERMATOLOGY
502.—Electric wet cell 470
503.—Series connection of cells 472
504.—Shunt rheostat connection 473
505.—Cell selector 474
506.—Cell selector and battery connection 474
507.—Milliampèremeter 475
508.—Direct current wall plate 475
509.—Wall-plate connections 475
510 _a_.—Portable wet cell apparatus 476
510 _b_.—Portable dry cell apparatus 477
511.—Sponge electrode 478
512.—Arm electrode 478
513, 514.—Electrolytic needle holders 479
515.—Interrupting current needle holder 479
516.—Needle holder with magnifying glass 479
517.—Epilating forceps 481
518.—Electrolysis method for destroying growths 483
519.—Multiple needle electrode 484
520.—Kolle electric apparatus for tattooing scars 487
CASE RECORDING METHODS
521.—Nose stencil 492
522.—Method of making nose plaster cast 494
PLASTIC AND COSMETIC SURGERY
CHAPTER I
HISTORICAL
It seems almost incredible that at this late day so little is generally
known to the surgical profession of the beautiful and practical, not
to say grateful, art of plastic or restorative surgery, successfully
practiced even by the ancients.
The progress of the art has been much interrupted. It is only the later
methods of antisepsis, which have so greatly added to general surgery,
that have placed it firmly upon the basis of a distinct and separate art
in surgical science.
To Aulus Cornelius Celsus, a Latin physician and philosopher, supposed to
have lived in the time of Augustus, we owe the first authentic principles
of the science. He was a most prolific writer and an urgent worker. After
having introduced the Hippocratic system to the Romans he became known as
the Roman Hippocrates. His best-known work handed down to us is the “De
Medicina,” the first edition of which, divided into eight books, appeared
in Florence in 1478. The seventh and eighth volumes, designated the
“Surgical Bible,” contain much valuable data in reference to opinions and
observations of the Alexandrian School of Medicine.
In considering plastic operations about the face (Curta in auribus,
labrisque ac naribus) he writes, “Ratio curationis ejus modi est; id
quod curtatum est, in quadratum redigere; ab interoribus ejus angulis
lineas transversas incidere, quæ citeriorem partem ab ulteriore ex
toto diducant; deinda ea quæ resolvimus, in unum adducere. Si non satis
junguntur, ultra lineas, quas ante fecimus, alias dua lunatas et ad
plagam conversas immittere, quibus summa tantum cutis diducatur, sic
enim fit, ut facilius quod adducitur, segui possit, quod non vi cogendum
est, sed ita adducendum ut ex facili subsequatur; et dimissum non multum
recedat.”
Centuries elapsed before a clear understanding of the above was deduced.
Several analyses have been advanced, those of O. Weber and Malgaigne
being the most generally accepted.
As shown in Fig. 1 the method advanced is one for the restoration or
repair of an irregular defect about the face in which two transverse
incisions forming angular skin flaps, dissected from the underlying
tissue, are advanced, joining the denuded free ends.
Should there be a lack of tissue to accomplish perfect coaptation a
semilunar incision beyond either outer border is added, as shown in Fig.
2, which permits of greater traction, leaving two small quatrespheral
areas to heal over by granulation:
[Illustration: FIG. 1.—CELSUS INCISION FOR RESTORATION OF DEFECT.]
[Illustration: FIG. 2.—CELSUS INCISION TO RELIEVE TENSION.]
This is the oldest known reference to plastic surgery of times remote.
From the Orient, however, Susrata in his Ayur-Veda, the exact period of
which is unknown, discloses the use of rhinoplastic methods.
For centuries following, and throughout the middle ages, the art seems to
have waned and remained practically unknown, as far as is shown in the
literature of that period.
A revivalist first appeared about the middle of the fifteenth century
in the person of Branca, of Catania, a Sicilian surgeon, who about 1442
established a reputation of building up noses from the skin of the face
(_exore_). His son Antonius enlarged upon his methods and is said to have
utilized the integument of the arm to accomplish the same result, thus
overcoming the extensive scarring of the face following the elder’s mode.
He seems to have been the first authority employing the so-called Italian
rhinoplastic method. He is also known to have ventured, more or less,
successfully in operations about the lips and ears.
Balthazar Pavoni and Mongitore repeated these methods of operative
procedure with more or less success and the brothers Bojanis acquired
great celebrity at Naples in the art of remodeling noses.
Vincent Vianeo followed the work of the above.
But, somehow, the heroic efforts of these men dropped so much into
oblivion that Fabricius ab Aquapende, in writing of the rhinoplastic work
of the brothers Bojani, of Calabria, says: “Primi qui modum reparandi
nasum coluere, fuerunt calabri; deinde devenit ad medicos Bononienses.”
That Germany was interested at an early date is shown in the admirable
work of a chevalier of the Teutonic Order, Brother Heinrich Von
Pfohlspundt, who wrote a book on the subject entitled “Buch der Brundth
Ertznei,” with a subtitle, “Eynem eine nawe nasse zu mache.” His volume
appeared in 1460, about the time of Antonio Branca, of whose methods
he was ignorant, claiming to have learned the art from an Italian who
succored many by his skill.
Between the years of 1546 and 1599 Kaspar Tagliacozzi, Professor at
Bologna, followed the art of rhinoplasty. His pupils published a book at
Venice, describing his work in 1597, entitled “De Corturum chirurgia per
insitionem,” which established the first authentic volume in restorative
surgery. His operation for restoring the entire nose from a double
pedicle flap taken from the arm was declared famous and the operation he
then advocated still bears his name.
The great Ambroise Pare knew little of rhinoplasty except what he learned
from hearsay. As an instance, he relates in 1575 that “A gentleman named
Cadet de Saint-Thoan, who had lost his nose, for a long time wore a nose
made of silver and while being much hurt by the criticisms and taunts
of his acquaintances heard of a master in Italy who restored noses. He
went there and had his facial organ restored, and returned to the great
surprise of his friends, who marveled at the change in their formerly
silver-nosed friend.”
Now again came a century of forgetfulness, the scientific world taking no
cognizance of the work done until, suddenly, in 1794, a message came from
Poonah, India, to the effect that an East Indian peasant named Cowasjee,
a cowherd following the English army, was captured by Tippo Sahib, who
ordered the prisoner’s nose to be amputated. His wounds were dressed and
healed by English surgeons. Shortly after this the victim of this odd
mode of punishment was befriended by the Koomas, a colony of potters,
or, as others claim, a religious sect, who knew how to restore the nose
by means of a flap taken from the forehead. They operated on him and
restored his nose much to the surprise of Pennant, who reported the case
in England.
Shortly following this, and in the same year, cases of similar nature are
described in the _Gentlemen’s Magazine_ (England), and Pennant’s “Views
of Hindoostan.”
In 1811 Lynn successfully accomplished the operation in a case in
England, and in 1814 Carpue published his results in two cases
successfully operated by him by the so-called Hindoo method.
France now took up the art of rhinoplasty. Delpech introduced a
modification of the method of the Koomas in 1820, while Lisfranc
performed the first operation of this nature in Paris in 1826.
In 1816 Graefe, of Germany, took up the work of Tagliacozzi but modified
his method by diminishing the number of operations.
Bünger, of Marburg, thereupon, in 1823, successfully made a man’s nose by
taking the necessary tegument from the patient’s thigh.
A still later modification in the art of rhinoplasty was that of Larrey,
who in 1830 overcame a large loss about the lobule of the nose by taking
the flaps to restore the same from the cheeks.
Among the better advocates of reparative chirurgery were Dieffenbach,
v. Langenbeck, Ricard, v. Graefe (1816), Alliot, Blandin, Zeis, Serre,
and Joberi, while Thomas D. Mutter, in 1831, published the results he
obtained in America—his co-workers being Warren and Pancoast.
Although Le Monier, a French dentist, as early as 1764 originally
proposed closure of the cleft in the soft palate, no one attempted
to carry out his suggestion until in 1819 the elder Roux, of Paris,
performed the operation. The following year Warren, of Boston,
independently decided upon and successfully did an improved operation to
the same end.
During the years 1865-70 Joseph Lister distinguished himself in the
discovery and meritorious employment of carbolic acid as a means of
destroying, or at least arresting, infectious germ life, the principle
of which, now so fully developed, has advanced the obtainable surgical
possibilities inestimably.
The credit of first collecting data of plastic operations belongs to
Szymanowski, of Russia. In his magnificent volume of surgery (1867), he
embodies a somewhat thorough treatise on restorative surgery, leaving
the subject to be treated more fully and independently, as it should be,
to some other enthusiastic surgeon specialist. His work is the result
of careful study of such operations on the cadaver, a method much to be
recommended to the prospective or operating plastic surgeon.
Several years later, 1871, Reverdin added a valuable method to the still
incomplete art, by introducing the now well-known circular epidermal
skin grafts for covering granulating surfaces. Thiersch improved this
method in 1886 by showing that comparatively large pieces of skin could
be transplanted. Wolfe, of Glasgow, had also been successful in utilizing
fairly large skin grafts.
Krause, however, improved upon all of these methods by transplanting
large flaps of skin without detaching the subcutaneous tissue, a
procedure which causes more or less injury to the graft in other methods,
and by his method overcoming the subsequent contraction, heretofore a bad
feature when the skin-grafted area had healed.
“The results of most plastic operations have been as satisfactory as the
most sanguine could hope for or the most critical expect,” says John Eric
Erichsen.
Many important additions have been made in the past few years—the outcome
of untiring attempt and skill. Czerny replaces part of an amputated
breast with a fatty tumor taken from the region of the thigh. Glück
successfully repairs a defect in the carotid artery with the aid of a
piece of the jugular vein. Glück, Helferich, and others have advocated
implanting muscular tissue taken from the dog into muscular deficiencies
in the human, due to whatever cause.
The transplantation of a zoöneural section into a defect of a nerve in
the human was successfully accomplished by Phillippeaux and Vulpian.
Glück, who later restored a sciatic nerve in a rabbit by the
transplantation of the same nerve taken from a hen, went so far as to
restore a 5-cm. defect of the radial nerve of a patient by the employment
of a bundle of catgut fibers, fully establishing the function of the
nerve within a year’s time.
Guthrie has successfully replaced the organs and limbs of animals and has
actually transplanted the heads of two dogs.
The transplantation of a toe, to make up a part of a lost finger, is
proposed by Nicoladoni. Van Lair hints at the possibility of removing a
part or a whole organ immediately before death to repair other living
organs.
Von Hippel has successfully implanted a zoöcorneal graft from a rabbit
upon the human eye, and Copeland has taken the corneal graft from one
human and transplanted it upon the cornea of another to overcome opacity.
The transplantation of pieces of bone to overcome a defect of like tissue
has been fully investigated by Ollier, v. Bergman, J. Wolff, MacEwen,
Jakimowitsch, Riedinger, and others. They discovered that a graft of
bone, with or without its periosteum, can be made to heal into a defect
when strict antisepsis is maintained.
Von Nussbaum was the first to introduce the closing of an osseous defect
by the use of a pedunculated flap of periosteum.
Poncet and Ollier employed small tubular sections of bone, while Senn has
obtained excellent results from the use of chips of aseptic decalcified
bone.
Hahn succeeded in implanting the fibula into a defect of the tibia.
On the other hand, cavities in the bones have been successfully filled
by Dreesmann and Heydenreich with a paste of plaster made with a
five-per-cent carbolic-acid solution, and at a later period by the
employment of paraffin (Gersuny) and iodoform wax, as advocated by
Mosetig-Moorhof.
The thyroid glands taken from the sheep, it is claimed, have been
successfully implanted in the abdomen of individuals whose thyroid glands
had been lost by disease or otherwise.
Protheses of celluloid compound or gutta-percha and painted to resemble
the nose or ear have been introduced with grateful result. Metal and
glass forms have been used to replace extirpated testicles or to take the
place of the vitreous humor of the eye (Mule).
Sunken noses have been raised with metal wire, metal plates, amber, and
caoutchouc. Metal plates have been skillfully fitted into the broken bony
vault of the cranium.
Lastly comes Gersuny’s most valuable method of injecting paraffin
compounds subcutaneously for the restoration of the contour of facial
surfaces and limbs, which is rapidly taking the place of extensive
plastic transplantory and the much-objected-to metal and bone-plate
operations for building up depressed noses and other abnormal cavities.
And the end of possibilities is not yet reached. The successful plastic
surgeon has become an imitator of nature’s beauty to-day.
His skill permits of many almost unbelievable corrections of defects
that would otherwise evoke the pity and too often the aversion of the
onlooker, especially if these occur in the faces of those that have
become marred in birth or age, by accident or disease. Withal, it is a
noble, generous art, worthy of far more extensive use than it now enjoys.
The above fragmentary references include a number of plastic
possibilities. They are introduced only in the sense of general interest
to the cosmetic surgeon, the special and detailed subject matter herein
given under the various divisions have to do only with plastic and
cosmetic operations about the face.