A Lost Nose Restored.
Talics'iiis hG lttelj btean d y Zehived in -111nce,.}where-it.is called the hlno.plasticy Optngerenl The fOllOwing translation of ihe report of a case which oceLirred in the- Hospital St. Elol,. of MlontpeUier, andl in which Professor Delech wasthe operatir,-is given in the last number of tbe L.a,Zcet. The pwataient was Charieo Sychal, a native-of Touloli, a satlor;i aged 20 yers. The whole of telso tft pust of the nosle wa's fdestrqed with the exception of a narrow ridge round the nosteih, whi'ch ~W formed by a remnant of cart!] e The patient was opernted up-n on the tte ofJune, 1823 in thefol- lowing manner - a gz aced him uponastrong chair, exposed so the light, we traced with ink the in ibe made to receIVe the edges of the flap which-was to aire the -breach of the tothe th ther cut out a paper mode( pnrthe tfint h the poztioin of bhead n sIgradfted, and laying this model dopen on the fore- transposing it from one side to the other, we marked it ofut with ink the forehead not being very open, we were obliged to e eiroach l a rse littmpedcsig sm omrs to eroach a irc,ttle, upon the part of the- skin covered with hair, whc wo eto from te lower part of the nose. Ever thing being thu 20tofvalvebof k a uhtonrrange adoly iienjrdot rouforr hthu rranged er n ad te t incisions as they w er en and u r ous d tuie breach ; b tot our line having been placea on all aides in the con- exitpo formed by the interior inclination of the rermnapt of ortilage, e orxer to prevent any'deformit ae loedt by ding veiecu Iryte wflapow thits x prouc moriffedatio.n. perpd eandiu tourlvce woite thet efrs, nremoving it entirelo , we contehted Ou'eviihParing the cicatrices, so as; to augment the surface to which the flapp s to be adapted. TTlihe flap was tien dissected, -nare being taken to iake it as thick as possible, without, however, laying bartle tbcronial. Thisportionofa,kit1lhad the form ofan aceof spadest rgveedb the stimllt portion destined to represent the cartilagianswered t the tail e the spade, and its point was represented by the pedicle ntf the flap, which was proloaged betwveen the eve-brows and the gltesoal angle of the eyes. 'The prolongation 'was extended to the PoInt where the turline down and twis ing of the flap coull be made withoutduiffculty. Three curved needles, with a inglt threadr In each were pale,ed across the extremity of the little prolongation desrnco toe make the lower edge of the cartilage, and around the loss of substance; which ad been nade opposite the central point Of the edge of the upper lip; and these three points of suture having been deyuled, this centralpportion of the bottom of the fla1S was adapted, and fixed the reet. Four similar points of suture were made on each side of the flap, and successively secured; the unitecd the whole circuraference, with the exception oF the UPPer Point formeethe pedicle. tvery where the proportion e thickness ofstue part was exact, and their adaption pero fret withOut employing any other means. Duiring this part Of the operation, the wound of the forehead was kept covered, to pre- yent the blood flowing on the parts on which we were operating; at was afterwnarls dtirssed with simple dressing, seine compresses, and . bandage. The operation was concluded. We had taken great care nt to makne ang useless waste of the forefead in a tranverse direction, while ive took, however, what wae nees- sary to extend from one ala of the nose to.-the other. -rhe dis- tance was great, and when the flap wasrtodapfcd the trawnsvetse re-traction which Iat experienced, anti 'to whiceh notlisn'g'was opposed, -reduced itos extenit in that directioan to the interval which separated these two poists in a straight line wa tout any elevation : it seemedr that this portinr. of skiTi was much too narrow, and only fit to form a sort of valve befoda the opening of thecose. The sstisftants. thought thni.he operations would he unavailing fromi this cause, and pressed us-troeng to put somelint tutner the flap, in order to push It for- ward, an'even to stretch it. one did not participate in their feros, and we yielded only from complaisance; we put bihind the cenegol point of diei flap a tew bits of lint, whtich we removed the ext lday without replaing them, lest by dloing violence to the fLap we should produse mortifmcation. We had learnt to place confidence in the efforts of nature, and our confidence was not disappoing ted. The operation was long and painful, owing to the minute attention wichd it demanded. r mmediatelv after ir, we gave the patient twagrains of' opium, wiic were repealed at night. He suffered pain for the s first four lhors after the operation. Second day, June .-Med had slept hut little; he comslained of his head,but not of his forehead. The flap was wam andi a little swelled-tile edges of the sutures were red and swollen, the pulse was thick esnd strong. Bleeding at the arm, twelve ounces low diet. Third day. He had slept a little in the night; pulse frequent tongue dry at theah t and in the median lineh polse quick and hard; the flap is swo oen, pale, utwarmer than the rest of the bedve; the circum- ference of the nose is red, swollen, and stretched.Bleeding in the arm 10 ouncest; repeated at noon, aiif In the evening; low diet. Fourth dav.;a tIe has slept at night ; theowelling of the face is less; pulshe less frequent, ad weaker. itwo basins ofrice- crea eon ead vearn, and lemonade for dlrink. Fifth dav.-Every thinsr is nearlv in a natured statei the sfwollen flap prejects for- -war , althoughnothing suppotar wit;the redness orfthe circum- ference of the sutures has disappeared withe deep surface ofs the flap is suppurating, the pus which it yields appears at its pedicle, and at the nostrils; the wound of the forehead is also siuppu- rating. Four basins of rice cream; the same irink. Sixth day.- ye took away all the sutures; the union was every where per- fect ; she form of the nose is determnined by the effect of the swell- ing, which the united edges of the flap cannot partakce. Two basins ofasoup. Seventh i av.-The union is no wbere disturbed; the wound of the fbreheash goes on suppurating, as well as that Of the flap. Ninth dav....All is ~well. Wve cut off the pedicle of the flap: the excess is preserved on the side of the forehead; at is raised and lodged in the lower part of the wound between the eyebrows. The aide opposite the sectioni is adapted to the sire of the nose) whiere we maine a fresh section ; we support the parts by three sutures. The patient resumes mercurial pills. Tenth and eleventh day.-T..he state of the flap is satisfactory. Twelfth day.-.We cut off the last suiture; the union is complete. Fourtenth du -A slight erysipelas appears on the lef't temiple. The pills le off, and a commnon purgative given ; low diet; in the evening the eruption spread towiards the ear. Nineteenith day.-Erysi- pelas entirely gone ; the natural form andl proportioni of the nose is more and mnore decided ; the circumference of the nostrils is rouinding; we favour this disposition by putting in two little hollow cones of ivory fixed to a string tied round the head. We allow solid food ; the patient resumes the mercucial pills. Up to the se- conid of July, the 28th day, the progress of the nose was re- mnarkabl rapid, especially when it is considered that the parts were left entirely to themselves. We applied a little nitrate of silver to the inside. Up to the 15th of .July the pills weezvnt the amnount of six, morning and evening, and we a3ded to each dose one containing a tenth of a grain of sublimate. 'The redness of the circumference of thie nose is disappearing ; the cicatrices of the upper lip are becomning firm ana white. On the Ist of August, the traces of the ingrafted nose were entirely lineal ; and thereseinblance or imitation of the original nose was thec astonishment of every one who beheld it. The woundl of the forehead is nearly cicatrised, and the deformity arising from it is very slight. The lvortfon of skin taken from the fnreheadt, which) was soft, undulating like.a valyc without action or consistence, has acquired the density of a nose fuarnished with cartilage, and it is the adhesion of the cellular surface wicih suppurated, to which this astonishing change is alone attributable. Upon quitting us, this young mian went to Toulon, where he still residles, and where he has been an object of general curiosity and astonishment, so happily has nature been imitated in his ar-tificial nose. A LOSAT NOSE RESTORED.