Minot P. Fryer

Management of compound facial injuries

Abstract In summary, an attempt has been made to correlate and re-emphasize principles of care of severe facial injuries, borrowing some material directly from previous publications.

Skin homografts from postmortem sources; clinical application.

Abstract For this summary several previous publications have been drawn from and the clinical conclusion is included in the first paragraph.

Repair of atomic, cathode-ray, cyclotron and x-ray burns of the hand: Long-term follow-up examinations and microscopic studies

Abstract Recorded experience in the treatment of radiation burns of the hands has directed efforts in the care of those burned by atomic, cyclotron and cathode-ray machine and x-ray sources. Results encourage continuance of this conservative management. Fingers have been saved and function of hands maintained by anticipating progressive breakdown, and carryout relative early resection and grafting.

Multiple internal wire fixation of facial fractures

Abstract Multiple wire pins have given simple, direct fixation adequate for solid union in severe compound facial injuries or crushes alone or in combination with other methods. Complicated, expensive, cumbersome external apparatus for traction or fixation is avoided.

Skin grafts about the face

Summary Free skin grafts are the simplest direct means for coverage of facial defects. Release of contractures and all tightness by excision of the deep scar to a good minute blood supply is followed with replacement of lost tissue with a skin graft. Particular areas about the face require specialized free grafts such as those from the supraclavicular region and composite grafts from the ear to the nose.

PLASTIC SURGERY FOR SEVERE FACIAL PARALYSIS IN ELDERLY PATIENTS

Facial nerve paralysis may have very distressing sequelae, chief among which are the lack of facial animation and the disfiguring sag of the cheeks, mouth and eyelids. Relief of this sag and some restoration of animation may be attained by anchoring strips of autogenous fascia lata to the tendon of the temporalis muscle and looping them through the drooping side of the face. This procedure may result in elevation of distorted features to practically normal position when the face is at rest. Eating, speaking, and other actions of the mouth are improved, and drooping of the lower eyelids and excessive tearing are lessened. In addition, the support given by this substitution of a fifth-nerve muscle for the paralyzed seventh-nerve muscles makes the face feel more confortable, and the small scars are not noticeable. Naturally, a complete return of function and emotional expression cannot be attained, and the action of the sound side of the face cannot be duplicated. Nevertheless, a worthwhile degree of muscle elevation and reanimation can be achieved, and there is marked subjective improvement. Objective improvement is possible, to the extent that others do not notice the paralysis when the face is at rest. There is no mass action or loss of function of other nerves, as may occur following nerve anastomosis. Obviously, every consideration should be given to nerve repair-by direct suture, transplant and graft-and each patient should be appraised by a neurologic surgeon, or by an otolaryngologist if the paralysis has followed surgery (e.g., mastoidectomy) or disease of the temporal bone. In the patients under discussion here, however, the paralysis and sagging of the face was of such long standing that nerve restoration had no practical application. This operation is indicated when there is permanent paralysis of the seventh nerve; when motor-nerve anastomosis is not possible or desirable; in temporary paralysis, to avoid overstretching of the paralyzed face and consequent loss of tone, while waiting for spontaneous return of nerve function; or, for the same reason, after a motor-nerve suture or anastomosis has been performed. The procedure is also of proven value when used in combination with motor-nerve anastomosis. When paralysis is permanent, the operation may be undertaken at any time, but preferably before overstretching of the face occurs. In long-standing cases, even though the facial muscles are elevated by operation, the skin may still hang over the facial loops like the webbing in elevated venetian blinds. Removal of this excess skin may take place before, at the time of, or after the facial transplant.