A Manual of Operative Surgery, Vol. 2 (Classic Reprint) - Softcover

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Excerpt from A Manual of Operative Surgery

This is applicable to small sinuses and fistula, to narrow linear and spindle-shaped gaps or fissures, and to such defects as the simpler forms of hare-lip. The margins of the fissure or opening are freshened by removing the integument which covers them. The strip of skin to be removed is grasped and steadied with fine-toothed forceps, while the strip is severed with a narrow scalpel or sharp-pointed tenotome. The portion removed should include not only the skin but also the subcutaneous tissues, and must be so free that the raw edges which are to be united are made out of sound and vascular structures. The edges of the fresh wound are carefully cleaned, bleed ing is checked by the pressure of a sponge, and the margins are approximated by fine silkworm gut or silk sutures. It is often well to leave the wound open for a while, to allow time for any bleeding to cease before the sutures are finally adjusted. In the case of larger gaps, or of fissures in dense tissues, tension may be relieved by undermining the margins of the wound for a certain distance with the scalpel (subcutaneous detachment). If this be not sufficient, two parallel incisions may be made upon either side of the cleft, as shown in Fig. 221.

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