The Operations of Surgery Volume 1 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1908 Excerpt: ...The moulding and squeezing the nose into a good shape must be done pretty vigorously, and must not cease till the paraffin is unimpressionable. The puncture is closed with collodion, and iced boracic acid lotion applied for a few hours. The immediate effect of the injection is to make the surrounding skin pale as well as tense. This pallor soon passes off. Pain is not, as a rule, much complained of. If no anaesthetic is given, there must be no movement when the puncture is made. As to the permanency of the results, Dr. Milligan states that cases, carefully watched for over a year, have shown no tendency to alter to any appreciable extent. Even if, after some years, absorption should take place, repetition of the injection would always be possible. Difficulties in effecting much improvement will chiefly arise in the following cases (Paget): --Where the skin is adherent, as after scarring due to syphilis, in cases chiefly congenital. Here the subcutaneous use of a fine tenotome may help. Connell (Journ. Ainer. Med. Assoc., Sept. 1903), in the case of very tight tissues, loosens them a few days before with a tenotome; at the time of the injection he uses sterilised saline solution before the paraffin. Where there is very little room between the forehead and the end of the nose, or where this is broad, coarse, or splayed out. The following are the chiej sequela which may be more or less disastrous. 1. Unless sufficient pressure is maintained all round the area injected very disfiguring nodules of paraffin may remain in the adjacent loose cellular tissue. The after-removal of them is a matter of the greatest difficulty from their adhesion to the connective tissue. 2. Thrombosis of the facial vein and pulmonary embolism have very rarely followed the injection of p..