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When performing operations on the skull and antrums, I have for years been impressed with the fact that when a bone-flap is to be formed and replaced, with the expectation of its preservation and ultimate reuniting, as in the "Beck frontal antrum operation," it is highly important that its periosteum be not detached, because the bone, as is well known, derived its nutrition largely from it. This is especially true in operations in presence of pus or infection, for the bone-flap must under such circumstances have more and better nourishment, and more perfect coaptation than would be necessary under aseptic conditions, in order to preserve its vitality, and insure its integrity and ultimate reunion.
Should the periosteum become detached from the bone-flap in performing the Beck operation, necrosis would follow, necessitating removal of the bone, which would cause scarring and depression deformity, and would be a great calamity to both
GREENE DM. CIRCULAR BLADE, HOLLOW AND GUARDED CHISELS. JAMA. 1911;LVII(18):1451. doi:10.1001/jama.1911.04260100277015
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