OCR Text |
Show 26 or THE CAxcnns or Inn LIr. or Inn HARELII'. In making the twisted suture, the lip is mom frequently too firmly braced, than not brought together sufficiently... When the ligature is drawn to stop the bleeding, as in the first instance, and not afterwards loosened, but the operation thus finished, the swelling of the part makes the ligature 2? posing its inner surface, we can dissect out the tumour, willy :out cutting its sac, and here as well as in accidental cuts of the lip, the edges will be best brought together by ligature. on THE HARELIB. much too tight, producing in consequence an irritation, which sometimes brings on suppuration, and bursting up of the wound. 5. i i i iE i r. l .‘ "4;:on mum f But when after a short delay, which allows the bleeding to stop,.and the parts which are in some degree already SWOlIcn, are brought accurately together. I have always found the operation succeed better, and without deformity. When a great part of the lip is taken away, and when the surfaces meet with difficulty, there is a straining on the pins.» and a consequent fretting of the wound.» This is another cause of failure- It may be often prevented, by carrying an adhesive strap, from cheek to cheek, and bringing it over the lip betwixt the pins, or perhaps nearer the chin, so as to sup« port the pins, but chiefly to act as a monitor, and to check the unwary motion of the lips. The wound should be kept dry, and: if« possible without" THE operation for the harelip, is the same with that just described, only that in some instances the irregularity of the cleft lip, requires a more peculiar nicety in adapting the ins eision, so as afterwards to bring the parts accurately together. Of the simple cleft we need say nothing further, than that the edges of it are to be pared off, with an uniform, firm inrision, and then to be brought together, as we have described in the case of cancer. we first separate the lip from the gums, if they are adhering, then we may either cut the lip on a piece of wood, put in betwixt the lip and gums, or use the harelip-forceps, to hold the lip while the edge is cut oil". r "WV" ".1 - "whirnh' f. .w:.r.,. rr'- _ ..., . . ‘ motion, that a scab may be formed. If a little matter should form, we are not to throw the parts loose, but let it‘ out, with! the point of a fine needle, and still retain the parts in contact. On the fourth 'day, I take out the lowermost pin, (allowing the threads to remain if they will) first carefully washing the pin with a camel's hair pencil, and clearing it of the adhering hard mucus, or blood. When the pin is withdrawn, without the point being previously, cleaned, it comes through with pain, and difficulty, and may even tear the new adhesions. After a slight suppuration has loosened the pins, they should not be allowed to remain, for they are in danger of deforming the lip. ~ .. There occur incysted tumours of the» fleshy part of the lip, which nothing but the knife will remove. I have taken them out by dissection, rather than as the cancerous lip is cut. Stretching the lip over the finger of an assistant, and OX" ' - :'-- my"... smwt In this form of the disease also, there can be but one way of operating, although it is sometimes performed with difficulty. ,The patient's head rests on the assistant's breast. The surgeon separates the lip from the gum, if it be necessary, then takes hold of the lip, of one side, with the harelip-forceps, leaving out from under their edge, what he means to cut OH‘, and with one motion of the scalpel he cuts this portion off-Then moving his instrument to the other side, he places it so, that he may pare off the edge of that also, and bring the ter~ mination of the cut accurately up, so as to form an angle with the first. |