A Flap of Periosteum From the Forehead

Tuapeka Times, Volume XXIV, Issue 1890, 23 April 1892, Page 1 (Supplement)

A Flap of Periosteum From the Forehead

Developed into a Substantial Nose Bridge -Curious Skin Grafting— A Patclx-WorJi Fac-d.

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Mrs. Hoffman, Brooklyn, had suffered from naaal catarrh until ebe had no noße left. Bonea as well bb tissueß were Ronp. In this condition Bbc applied to Dr. F. L. E. Teiamore to see whether he oonld build a noae.

The dootor, after an examination of the case, had her placed under the influence ot an anse3thetio. Then he cut away the skin that covered tho nasal cavity. Next tha flesh on the forehead, immediately above the nose, was dissected back in flapp, ho as to lay bare a wedge-shaped portion of the skull there. The bone is covered with a skin, as nearly everyone knowß, and a flap of this bone ekin (periosteum) of the Bhape of a truncated V waa dissected from the bone, save only that tha pomt of the V was left attached to the skull between the cyea. Thia flap was twisted bo that when it was laid down over the nasal cavity the Bide that had been next to the bone was down. Meantime a live chicken had been cnt open and a piece of ita breastbone of the right eize and shape to form a noeo waß cat out and stitched fact over the nasal cavity. This bone formed a bridge which supported the flap of periosteum up in the Fhapa of a nose. The periosteum Was therefore stitched over thia bridge. Then, when that waa done, the skin and tissues from tbe cheeks of tha patient were drawn np over the new nose and Etitched there, forming the fleßhy part of the nose.

Oi course every care was taken in tbe uea of antieepticß. At the end of ten £ays tha chicken bone came away. Meantime the periosteum had developed into a thin shell of bone perfectly able to support Heelf, and » membrane had grown over what had now become tha nostrils of the new noee. Of course provision bad been made for the growth of a central cartilage as well as an outer framework. At tho end of twelve days the outer wounda had healed, including the wound on the forehead, from whioh the periosteum had been removed. The interior of the noee waa lonper in healinf, but it iff now wtll, and Mrp. Hoffman ocoe more has a nose that she ie proitd of.

" When I adopted tho chicken bone," said Dr. Tetamore, when asked about the case, " I did it because i& was of about the right form and because I wanted to ccc whether it would really grow into the place and eerve the purpose. It was not a new idea, for the flesh of animals has hitherto been grafted into that of human beings. But I was perfectly cure that the periosteum would develop a thia plate of bone, and that was all thst was needed. The chicken bone aerved meantime 08 a eupporfc."

Dr. Tetsmore has a mere difficult case on hand than that of Mrs. Hoffman. It is that of a woman who baa lost her nose and is co terrible deformed that there is not enough flesh and tissue on the eides of the nasal cavity to draw up over it when a new noae shall be made for it from the periosteum from the forehead.

In dealing with thia oase Dr. Tetamore has diecarded the chicken bone entirely, and for the Bupport of tbe nose he substituted a frame work made of thin slats of ivioy.

To begin with he made a plaster cast of the woman's face. Then he took soft rubber and constructed a nose of the proper form to fit that plaoe. This rubber nose gave the size and shape of framework neoessary to support the new nose and the size of the flap to be cut from the forehead. Having made the ivory frame in his office, he had the woman placed on tho dissecting table and dissected away the flesh from around the nasal cavity and laid bare the bone all around. Then he fastened the ivory frame over the nasal cavity by tacking the ends of the ivory slats fast to the exposed bone with ivory tree nails. This done, a flap not only of periosteum from the skull above the eyes, but its covering of flesh and skin wexe lifted up, twisted around and laid down over the ivory frame-work, provision beiDg made for the middle oartilage as before. This flap was sewed down to tbe flesh of the face and the lip. The wide wound on the forehead will, doubtless, fill up, as olean-out wounds always do. Th* flap over the ivory frame will grow around over it, and it will always remain there. Such is the present aspect.

A case of skin-grafting in Williameburg was interesting because it showed how in the growth of any part of the human body its natural characteristics are accurately preserved. The patient bad a severe barn on the face, and the wound would sot heal. So bits of skin were grafted over the wound, and in that way euocesa attained. But the novel feature of the oase was that a great variety of human cuticle was ueed. Skin from the legs of hairy men, patches of skin that had moles on them, and the skin of colored people were ueed, and they all grew fast — a curious-looking patch-work. But very soon after each patch grew fast it began to change its character until at last the cheek that had been burned was white and fair like the other one, no trace of hair, or mole, or colored folka remaining.