SOME SURGICAL WONDERS

I MAKING NEW FACES FOB OUR ' SOLDIERS. AN AUCKLAND DOCTOR'S LETTER. 1 Mr. R. Tudehope has received from his son (Dr. C- B. Tudehope) some interesting information of the surgical wonders which are being performed in military hospitals by Surgeon Sir Arbuthnot Lane, with whom he is associated, showing what now can be done for our suffering heroes. "Somewhere in England" there exists a hospital for the treatment of our deformed and disfigured heroes. Within its wards, gay with flowers, where the surgeon is as devoted as he is skilful, and no pains are spared by the nurses to brighten the days of those whose fate is tragic beyond all words, there exist some hundreds of men who cannot be seen in public unless they are masked. There are faces that are no longer faces, where deep yawning caverns stand open in the place of features, 'horrors that repel even the boldest mind, and from which the eye recoils in terror. Yet these men suffer no pain, and tbe one outstanding fact about them is their amazing cheerfulness. Where even the steeled nerves of the surgeon almost fail him. the spirit of these simple, ordinary men has risen triumphant. I know of no finer instance of human courage grappling with the situation that one would think would appal the stoutest heart. They are here to have their faces remade—features that are gone replaced. How can it be done? In the first place, they are photographed by means of the X-rays, so that the surgeon may know and see the exact condition that he has to make good. In this hospital, too, there happens to be a very distinguished artist, who is also a doctor; he has executed a series of pastels, done before and after operation, which are worthy of an exhibition. The next thing—and the first step in the operative procedure—is to decide on the framework on which the new features are to be set. If the upper jaw is driven in it can be elevated; if the bony part of the nose is missing, and this is generally the ease, it can be re. placed by a piece of a rib or a rib cartilage taken from the patient's Bide. If the lower jaw is shattered, or partly missing, it can be united or bridged over by a metal plate, or a piece of bone can be grafted in to fill the gap. The making of the jaw is the special work of the dental surgeons who are attached to the staff of the hospital, but it iB worthy of remark that the joining together of bones, either in the jaws or elsewhere, with a degree of accuracy ; and closeness of justapositiOn hitherto impossible is due to the skilL and enterprise of Sir Arbuthnot Lane, whose name will be inseparably connected with what is known as "boneplating."' and whose reputation is worldwide. Let us blow our own trumpets for once, for in this remarkable operation England has led the world. The bony or cartilaginous structure erected and completed, there comes the crucial problem of the new face. Skin I can be grafted and muscle can be grafted Ito form a pad for the skin, but it has in these cases to be done on a scale hitherto i uncontemplated. The old methods of ( I shaving off innumerable tiny little pieces of the outermost skin or epidermis j would be of no use here. Large areas 1 have to be taken. The method adopted I is somewhat of this nature: The edges of' the gap that has to be refilled are first of all pared or freshened, as it is called, so that the transplanted skirt may bite or grow on them. From the patient's t>wn arm a flap of skin, of such a size and shape as accurately to fit in the gap required to be covered on the face, i» lifted. It is detached everywhere except at one corner, so as to allow it to live on its own supply of blood. It is then twisted on its own axis and its under surface applied to the face, where its edges are stitched to the edges of the area uncovered by any skin. This procedure, of course, carries the arm up with it to the side of the head, where it , has to be held "in situ" until the transplanted skin has grown to the face. This process takes about three weeks, therefore it is necessary to devise some form of aluminium apparatus fixed to the head in which the hand may rest comfortably. It is also necessary to practice holding the hand in this constrained position beforehand. As soon as the graft has "taken" the slip of skin still attached to the arm is severed, and the operation is complete. Its success depends on two main factors. One is the skill of the surgeon in planning and mapping out "the graft": the second is the asepsis or perfect surgical cleanliness with which it is carried out. Unless this is perfect the "grafts" fail to take. And as to the results? The hideous deformities no longer exist, the gaping cavern is filled in: the nose, the cheeks, or the jaws are re-created, and the sufferer can walk about with his fellow-men.' That is n veritable triumph.