PLASTIC SURGERY.

Otaki Mail, Volume 26, 26 September 1919, Page 4

PLASTIC SURGERY.

FACIAL AND JAW INJURIES. SOME DETAILS OP THE TREATMENT. VALUABLE SYSTEM OF RECORDS. (From "Otago Daily Times.") Plastic surgery as applied to the treatment of facial and jaw injuries Which have been received in battle is one of the most -wonderful developments made by medical science as a result of the war. As soon as the great value of this science was recognised close research work and experimentation brought about rapid advances in its practical application, and as an outcome of this- specialisation many a man who would formerly have had to bear disfigurement for the rest of his days can now face the world with quite a presentable appearance. A.few weeks ago a technical annexe for the treatment of facial and. jaw cases amongst the soldiers was completed beside the Dunedin Hospital, and here Lieutenant-Colonel Piekcrill, who is in charge of the work, has installed the; requisite equipment. One portion of this compact and well furnished building, which was erected by tlie Red Cross Society, is used- as an office and records room and also as a clinic. The records, which are most complete, are kept by means of photographs, water-colour sketches, diagrams and wax models.and they show in detail every stage of the treatment to which the patient has been subjected. On tho staff there is a dental mechanic, a modeller, a water-colour artist, and a photographer, each of whom has his special department in which to work and his special mission to carry out in j the general co-ordinated scheme. At the present time there are about lifty men in the Sidcup ward of the hospital and at Woodside who have lost parts of: the face and jaw which have to be restored by means of plastic surgery. A detailed record is kept of the progress of each patient, and these records apart from their use from-the point of view of future treatment will have a great historical value. In England, according to Lieutenant-Colonel Piekcrill, the New Zealand Medical Corps had the finest system of records of any branch of the medical services in connection with plastic surgery, and a similar system is being kept in operation here. "When these records arc*"completed they will be tabulated and classified, and in the future should constitute) valuable data for the treatment of any cases which may. arise in any department of life.

The work of treating jaw and facial injuries is a slow and gradual process, in which the skill of man is linked with the influences of nature to produce the beneficial results aimed at. Some »f the patients at present under treatment have been in hospital for 12 or IS months, and a few have been there as long as two years. It is not pretended that a man can be supplied with a comX>lctc face, but the marvels of plastic surgery are so great that he can be provided with new features similar to those which he originally possessed. Before the war medical surgery sought to achieve this result by one big operation, but experience has shown the necessity for carrying out the treatment in stages in order to avoid residual sepsis, which, if it sets in, nullities "all the work that has been done. Nowadays a man has to undergo, for his own benefit, a scries of operations extending over a considerable period and numbering from five or six up to as many as ten or twelve in the more serious eases. This work is carried out by a medical operator in conjunction with a dental expert, and thus a complete course of treatment is sought, to be carried out. The operations are, of course, performed under an antesthetic. and while they do not involve a great deal of pain it is obvious that facial surgery of tiny kind involves a considerable amount of discomfort.

When a man requires a new nose he can i>c supplied with one practically to order. It' his features were aquiline before injury they can be so restored as to be still aquiline, and the same result can be attained in dealing with the various other types of noses. Skin for the replacement of a nose is obtained by cutting a flap from the forehead. This is then detached at the upper end. in order to retain the blood ~->lr, and after being folded over it is «rifted oS io * hc in J urcd P art ' vniQn it has set It is defiS 6 * 9* th . e lower end also. When cartilage is ?e£ a i re " for the nose it is obtained from a rib, and is so grafted on that the original structure of the organ is preserved in its entirety. Skin for the upper lip is obtained from the scalp, and it is grafted on in such a way that the injured man is able to grow a moustache from the hair which once grew on his head. Certain difficulties would, of course, arise in the case of a man whose head was bald, but no doubt even this difficulty would be surmounted. For injuries to the lower lip the skin is obtained from, the neck or chest in the same manner as in other cases, and operations have been performed in which two relays of skin have been detached when such a course was Tendered necessary. It may be added that a course of treatment has been devised by which it is possible to replace the skin which has been removed for remedial purposes in another part. In future it will be possible, as previously indicated, to apply plastic sur- . gory to the treatment of ordinary hospital eases, and where a pateient, for instance, has developed some malignant disease of the nose it may be found advantageous to remove the organ altogether and to replace it by means of & series of operations in plastic surgery.