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Plastic surgery principally concerns the repair of skin or mucous membrane defects. Direct approximation of edges, by undermining and stretching, fixed by sutures, is easy and sure of satisfactory results if tension is not too great and the tissue healthy. This method may be aided by lateral subsidiary incisions to facilitate sliding, the lateral clefts being left to granulate and cicatrize, or are closed by grafts placed at once, or as soon as. good healthy granulation tissue has formed.
Flap formation, with or without twisting of the pedicle, will in some cases serve a useful purpose. Marginal connection of flaps from a distant part of the body, released from pedicle connection later, has a very limited field. The confinement is most irksome; besides, the vitality of the disconnected flap is feeble for a long time. In all cases where the new skin can be made to rest upon an underlying,
RUTH CE. PLASTIC SURGERY, WITH CASES.—FORMATION OF NEW CHEEK. JAMA. 1902;XXXVIII(19):1203–1207. doi:10.1001/jama.1902.62480190009001a
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