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Esser, the well known cosmopolitan Dutch specialist in plastic surgery, describes in a handsome volume, which contains four hundred and twenty illustrations, how plastic operations on the face may be performed.
His method is fundamentally different from that which is usually followed in transplantations with pedicles. The difference consists in the absence of skin in the pedicles of the flaps ; on the other hand, stress is laid on the fact that the nutrition of flaps is largely dependent on the presence of arteries, veins, lymph vessels and nerves in the stalks. The presence of skin in the pedicle is considered a disadvantage. A cutaneous excess is ugly ; moreover, when the stalk is twisted the skin may exert a pressure on the vessels. Eventually additional corrective operations are necessary. Thus, the presence of skin in the stalks is not economical, so far as trouble, time and skin
VAN DER Hoeve. Biological or Artery Flaps of the Face. Arch Ophthalmol. 1936;15(1):153. doi:10.1001/archopht.1936.00840130163023
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