Surgery.

Date:
[1913]
Catalogue details

Licence: In copyright

Credit: Surgery. Source: Wellcome Collection.

    50/412 page 42
    What is the Treatment ? In very early cases local excision of the ulcer may be possible, but surgery in all other cases must aim at excision of the tumour and its area of lymphatic drainage. Radium and X-ray therapy are satisfactory and less mutilating. Describe Melanoma. A simple melanoma resembles the ordinary papilloma of the skin, and treatment is only necessary when it is subject to irritation or for cosmetic reasons. The tumour should be excised. If the tumour suddenly begins to grow larger or ulceration occurs malignant change is likely. The tumour spreads rapidly to the lymphatics and is rapidly fatal in spite of widespread excisions. What Methods of Skin-Grafting are Employed ? Four methods of skin grafting are employed : (a) Thiersch's method employs the superficial layer of the skin, the line of section passing through the tips of the papillae. The graft is laid on the surface of a mould, which is applied to the granulating surface. Care must be taken to make the grafts overlap the edges of the wound and the adjoining grafts. (b) When whole thickness grafts are required the pedicle graft is used, the tube of skin being formed at the first operation and transferred in stages to the raw surface. (c) The healing of large areas may be expedited by the use of pinch grafts (Reverdin’s method) which are obtained by lifting up small “ pinches ” of skin with the point of a needle, cutting them off with a sharp knife and sowing them over the raw surface. (d) Cutis vera grafts from which the epidermis has been scraped off are employed subcutaneously for the repair of large hernia?, the graft being placed in the area and be- coming replaced bv fibrous tissue.
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