100 PLASTIC SURGERY
CASE 245
This sergeant was admitted in a healed condition. There was partial loss of the pre-maxilla, and loss of more than half of the upper lip, together with an ugly twisting of the nose, and depression of the tip. This patient was operated on four months after the receipt of his wound. It will be noticed in the appended operation notes that he developed bronchitis after the operation. Therefore the failure to get a really satisfactory result may well be put down to this trouble, as the coughing which followed undoubtedly prejudiced the union of the flaps. Three weeks after this operation the patient, when at a Convalescent Hospital, developed septic pneumonia, from which he recovered slowly.
Although the record number is a late one, this was one of my early cases, and it brought home to me the necessity for some different form of anaesthesia from that usually employed in mouth cases, and in those of chin and upper lip in particular. In the pages on anaesthesia this matter is fully dealt with. A fairly satisfactory result was obtained from an aesthetic point of view, and, functionally, it was good. It should be remarked,
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however, that a secondary deformity of the lower lip was produced. Since the date on which the last illustration, fig. 161, was taken, this sergeant has done a year's duty with Home troops. Details of operations on this case follow :
22.6.16. Operation. Formation of upper lip. The flap of skin and mucous membrane representing the remains of the upper lip was dissected out from left nostril, and by an incision parallel to the lip margin the flap was brought over towards the right to meet two flaps from the right side which were separated by a piece of excised scar. The lower of these flaps was a small one, containing the angle of the mouth. Result : The dental shield for the new lip which had been made was not tolerated by the patient, who had some bronchitis after the operation. A certain amount of breaking down occurred at the junction, and owing to the absence of intra-oral apparatus the new lip became adherent to the alveolus of the upper jaw. Apparatus for distending of lip after division
