On some important advantages to be secured by oblique section of the skin in surgical operations / by John H. Packard.

  • Packard, John H. (John Hooker), 1832-1907.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On some important advantages to be secured by oblique section of the skin in surgical operations / by John H. Packard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    element. But it did not seem to him that the idea of the open method militated against his theory of oblique incision at all. The remarks of Dr. Wood reminded him of what Sir J. Paget says of the distinction between immediate union and union by first intention. He thought the distinction an important one. In im- mediate union, there is union with no effusion of lymph. Now, by the oblique method, this union is more likely to be obtained. And the point is, in this incision, to so cut the skin as to have the edges closely in apposition, and the sides of the wound so brought together as to prevent the formation of any cavity; the atmos- pheric pressure helps to secure this result. 2d. In reference to the danger of sloughing, he referred to cases of skin-grafting. The facts regarding this were a sufficient answer to the suggested danger. 3d. In regard to how much beveling of the skin there should be, demonstrations would show it more perfectly than description. The incision must be made very obliquely, the knife being held at an angle of 150° or more. There is all the difference in the world between such extreme obliquity and a slight amount. Some surgeons had totally misapprehended him on this point. 4th. Dr. Packard was aware that the idea of oblique incisions ' was not new. He recollected Dr. Pancoast’s operation for rhino- 1, plasty, referred to by Dr. Wood. This was, however, for a special f operation only. The points he (Dr. Packard) urged, were the uniform advantages of the oblique incision in securing accurate h apposition of the skin, and in preventing the formation of a cavity, [Note by the Author of the paper.—It cannot be denied that t cases do occur, such as those cited above by Drs. Harwood and i Webster, in which union takes place rapidly and without trouble- | some scarring, no matter how the skin is divided. But it is not i the less important to insure the ready healing of operation-wounds, C by any available means; and such seems to be the result of the | method of incision above described. . . . 5 Where, as in country practice, cases have to be left unvisited ,, for two or three days, there is no risk of mischief from rapid clos- i ure. Especially if drainage is used, and if pressure is properly | made so as to diminish the size of the cavity left, as, for instance, ^ after the removal of a tumor, the adhesion of the lips of the wound can be productive of no possible harm.] r ■A